scholarly journals Standard of Care and Outcomes of Primary Laparotomy Versus Laparotomy in Patients with Prior Open Abdominal Surgery (ReLap Study; DRKS00013001)

2021 ◽  
Author(s):  
Dinh Thien-An Tran ◽  
Rosa Klotz ◽  
Julian C. Harnoss ◽  
Patrick Heger ◽  
Alina S. Ritter ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Wound Dehiscence ◽  
Standard Of Care ◽  
Controlled Clinical Trial ◽  
Comprehensive Complication Index ◽  
Prospective Comparison ◽  
Long Term Follow Up ◽  
Perioperative Course ◽  
Level Of Significance

Abstract Background Patients undergoing relaparotomy are generally underrepresented in trials, despite how common the procedure is in clinical practice. The aim of this trial was to determine standard of care and gain evidence of intra- and postoperative outcomes for patients undergoing relaparotomy compared to primary laparotomy. Methods In this single-center controlled clinical trial, adult patients scheduled for elective abdominal surgery via relaparotomy or primary laparotomy were consecutively screened for eligibility. The perioperative course was monitored prospectively in five study visits during hospital stay and one study visit 1 year after surgery. Intraoperative standards, short and long-term outcomes were statistically explored at a level of significance of 5%. Results A total of 131 patients with relaparotomy and 50 patients with primary laparotomy were analyzed. In the relaparotomy group, the access to the abdomen took longer (23.5 min vs. 8.8 min; p = < 0.001) and the peritoneal adhesion index was higher (10.8 vs. 0.4; p = < 0.001). Inadvertent enterotomies were more frequent in the relaparotomy group (relaparotomy 0.3 versus primary laparotomy: 0.0; p = 0.002). The overall comprehensive complication index and rates of surgical site infection and wound dehiscence with evisceration were not different between the two groups. At long-term follow-up, rates of incisional hernia did not differ (relaparotomy: n = 12/104 (11.5%); primary laparotomy: n = 7/35 (20.0%); p = 0.208). Discussion In this first prospective comparison of relaparotomy with primary laparotomy, inadvertent enterotomies were more frequent in the relaparotomy group. However, contrary to previous retrospective studies, the risk of complications and incisional hernias was not increased compared to primary laparotomy. Trial Registration Deutsches Register Klinischer Studien (www.germanctr.de): DRKS00013001

Su1482 THE DURABILITY OF ENDOSCOPIC ULTRASOUND-GUIDED ABLATION OF PANCREATIC CYSTS: A LONG-TERM FOLLOW-UP OF THE CHARM PROSPECTIVE, RANDOMIZED, CONTROLLED CLINICAL TRIAL

2020 ◽  
Vol 158 (6) ◽  
pp. S-597
Author(s):  
Courtney Lester ◽  
Leonard Walsh ◽  
Kayla M. Hartz ◽  
Abraham Mathew ◽  
John M. Levenick ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Endoscopic Ultrasound ◽  
Pancreatic Cysts ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Long Term Follow Up

A Meta-analysis of the Types and Outcomes of Conservative Excisional Surgery for Recalcitrant or Infected Diabetic Toe Ulcers

2019 ◽  
Vol 13 (2) ◽  
pp. 152-160 ◽  
Author(s):  
Kaissar Yammine ◽  
Chahine Assi
Keyword(s):  
Healing Rate ◽  
Meta Analysis ◽  
Recurrent Infection ◽  
Wound Dehiscence ◽  
Standard Of Care ◽  
Conservative Surgery ◽  
Healing Time ◽  
Excisional Surgery ◽  
Toe Amputation

Although they occur frequently, diabetic toe ulcers (DTUs) are poorly investigated. Long-term antibiotics or toe amputation are the usual indications for complicated DTU treatment. Some authors reported good to excellent results following conservative surgery (CS) for recalcitrant or infected wounds; yet no systematic review has been published. Seven studies, comprising 290 patients with 317 ulcers, met the inclusion criteria of this meta-analysis. Three types of CS were found: resection arthroplasty of the interphalangeal joint, toe-sparing bone excision (internal pedal amputation), and distal Symes amputation. The meta-analytical results were as follows: healing rate of 98.3%, healing time of 6.8 ± 3.9 weeks, recurrence rate of 2.3%, wound dehiscence/recurrent infection rate of 6.4%, skin necrosis rate of 2.8%, and revision surgery rate of 7.4%. Subgroup analyses showed no significant differences in outcomes between recalcitrant ulcers and infected ulcers nor between surgery types. Significance was found in relation to ulcer location; when compared with the hallux, DTU on the lesser toes demonstrated better outcomes. Compared with the reported overall results of standard of care associated with antibiotics or toe amputation of complicated DTUs in the literature, CS seems to be a better option for the treatment of recalcitrant or infected DTUs. Levels of Evidence: Level III

Common Calcaneal Tenorrhaphy Revision Using a Central Gastrocnemius Turnover Aponeurotic Flap Technique in a Cat

2018 ◽  
Vol 31 (01) ◽  
pp. 067-070 ◽  
Author(s):  
Fabio Sangion ◽  
Guido Pisani ◽  
Filippo Cinti
Keyword(s):  
Achilles Tendon ◽  
Tendon Healing ◽  
Wound Dehiscence ◽  
Good Health ◽  
Activity Level ◽  
Normal Gait ◽  
Proximal Stump ◽  
Long Term Follow Up

A 5-year-old, male castrated, domestic short hair cat was referred to the authors' clinic because of wound dehiscence and exposure of tendon stumps after tenorrhaphy of the Achilles tendon. Surgical revision was done using an aponeurotic flap taken from the proximal stump of the Achilles tendon and sutured over the two tendon portions. This technique has been described in humans, but, to the authors' knowledge, this has not been reported in cats. Modified type II external fixation was used to maintain the tarsocrural joint in extension until tendon healing was confirmed ultrasonographically 35 days postoperatively. Clinical and ultrasonographic evaluation 60 and 120 days postoperatively showed normal limb function and good tendon healing. Long-term follow-up examination 8 years postoperatively revealed that the cat was in good health with normal gait and activity level.

scholarly journals Bilateral Sander IV calcaneus fractures: Primary fusion or fixation?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0006
Author(s):  
Rajiv Shah
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Standard Of Care ◽  
Calcaneus Fracture ◽  
Subtalar Fusion ◽  
Fall From Height ◽  
Long Term Follow Up ◽  
Calcaneus Fractures

Category: Trauma Introduction/Purpose: Primary subtalar fusion for Sander IV calcaneus fractures was considered to be the standard of care till recent past. Presently debate is on whether to manage Sander IV calcaneus fracture cases with primary subtalar fusion or with open reduction and internal fixation. Bilateral Sander IV calcaneus fractures are seen in cases with fall from height. No study has ever been conducted till date to compare the results of primary fusion of a Sander IV calcaneus fracture on one side and open reduction and internal fixation on another side in cases with bilateral Sander IV calcaneus fractures. We present a study comparing the results of primary fusion versus open reduction and internal fixation for bilateral sander IV calcaneus fracture cases. Methods: Twelve cases with bilateral closed Sander IV calcaneus fractures where included in the present study. Cases were operated between four to six weeks by a single surgeon after the appearance of wrinkles. All right sided fractures underwent open reduction and internal fixation with proximal tibia grafting. While all left-sided fractures underwent subtalar fusion with the use of ipsilateral anterior iliac crest grafts. Cases were followed up for 24 months. Results: Though operative time was more in the fusion group wound problems were equal in both the groups. Four months of average time to union was the same in both the groups and so was time to return to work. At two years, the AOFAS score was slightly better in the fusion group but it was not statistically significant. Conclusion: Primary subtalar fusion is with almost similar results as those with open reduction and internal fixation in bilateral Sander IV at 24 months. Long term follow up with more number of cases is required to prove the benefit of one over other.

scholarly journals Long-term follow-up of a randomized, controlled clinical trial of three therapeutic strategies for multivessel stable coronary artery disease in women

2014 ◽  
Vol 19 (6) ◽  
pp. 997-1001 ◽  
Author(s):  
Antonio de Padua Mansur ◽  
Whady Armino Hueb ◽  
Julio Yoshio Takada ◽  
Solange Desirée Avakian ◽  
Paulo Roberto Soares ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Stable Coronary Artery Disease ◽  
Therapeutic Strategies ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Long Term Follow Up ◽  
Artery Disease

scholarly journals Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy

2009 ◽  
Vol 24 (12) ◽  
pp. 3694-3701 ◽  
Author(s):  
C. Manno ◽  
D. D. Torres ◽  
M. Rossini ◽  
F. Pesce ◽  
F. P. Schena
Keyword(s):  
Clinical Trial ◽  
Iga Nephropathy ◽  
Ace Inhibitors ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Long Term Follow Up

Complications following midfoot amputation in neuropathic and dysvascular feet

1989 ◽  
Vol 79 (6) ◽  
pp. 277-280 ◽  
Author(s):  
R Sage ◽  
MS Pinzur ◽  
R Cronin ◽  
HF Preuss ◽  
H Osterman
Keyword(s):  
Success Rate ◽  
Wound Dehiscence ◽  
Aggressive Management ◽  
Long Term Follow Up ◽  
Early Wound

A review of 64 midfoot amputations performed between 1980 and 1985 revealed that complications occurred in 42% of the series. These included early wound dehiscence and late re-ulceration after the patient began walking again. By providing aggressive management and appropriate local revisions, 84% of the original group's limbs were salvaged at a functionally significant level. These findings underscore the fact that midfoot amputation requires diligent immediate and long-term follow-up if an acceptable success rate is to be achieved.

scholarly journals Penetrance of hypertrophic cardiomyopathy and outcome in sarcomeric mutation carriers

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Lorenzini ◽  
G Norrish ◽  
E Field ◽  
J.P Ochoa ◽  
M Cicerchia ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Gene Mutations ◽  
Standard Of Care ◽  
Current Standard ◽  
Mutation Carriers ◽  
Disease Penetrance ◽  
Long Term Follow Up ◽  
Few Data

Abstract Background Predictive genetic screening of the first degree relatives of patients with hypertrophic cardiomyopathy (HCM) caused by sarcomere protein (SP) gene mutations is current standard of care, but there are few data on long-term outcomes in mutation carriers without HCM. Purpose To establish the role of sex and genotype in HCM penetrance as well as the rate of major adverse clinical events in SP mutation carriers and following the diagnosis of HCM. Methods Retrospective analysis of consecutive adult and paediatric SP mutation carriers identified during family screening and who did not fulfill diagnostic criteria for HCM at first evaluation. Results 321 individuals from 170 families [median age first evaluation 15.2 years (IQR 7.3–32.6); 153 (47.7%) males] were evaluated. Causal SP genes were: MYBPC3 (n=133 (41.4%)), MYH7 (n=77 (24.0%)), TNNI3 (n=51 (15.9%)), TNNT2 (n=40 (12.5%)), TPM1 (n=9 (2.8%)), MYL2 (n=6 (1.9%)), and ACTC1 (n=1 (0.3%)); 4 (1.3%) carried multiple mutations. After a median follow up of 7.4 years (IQR 2.5–12.7), 89 (27.7%) patients developed HCM. Disease penetrance at the age of 50 years was 47% (95% CI 38%-56%). One hundred and fifty three (47.7%) individuals underwent cardiac magnetic resonance (CMR) imaging; among those diagnosed with HCM, 22/89 (24.7%) fulfilled criteria on CMR but not echocardiography. In a multivariable model adjusted for genotype, follow up duration and evaluation with CMR, independent predictors of HCM development were male sex (HR 3.11; CI 1.82–5.32) and abnormal ECG (HR 7.87; CI 4.43–13.97). Patients with MYH7 and multiple mutations were more likely to develop HCM than those with MYBPC3 mutations (HR 2.03; CI 1.04–3.96 and HR 10.13; CI 1.40–72.92, respectively). Disease penetrance was lowest in carriers of TNNI3 mutations (HR 0.13; CI 0.03–0.48). There were no major adverse events in individuals without HCM. Following the diagnosis of HCM, the combined rate of all-cause death, appropriate defibrillator shock or resuscitated cardiac arrest was 1.1%/year [median follow up 4.0 years (IQR 2.1–8.9)]. Conclusions Approximately 50% of SP mutation carriers develop HCM by the age of 50 and become prone to disease complications during long-term follow-up. Sex, MYH7 mutations and the presence of an abnormal ECG are associated with a higher risk of disease development. CMR should be employed systematically in long-term screening. HCM penetrance by sex Funding Acknowledgement Type of funding source: None

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