Long term complications after radical cystoprostatectomy with orthotopic diversion in male patients: Preliminary experience

Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.

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Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Angiology ◽

10.1177/0003319720987956 ◽

2021 ◽

pp. 000331972098795

Author(s):

Songyuan Luo ◽

Yi Zhu ◽

Enmin Xie ◽

Huanyu Ding ◽

Fan Yang ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Outcomes ◽

Cox Regression ◽

Type B ◽

Type B Aortic Dissection ◽

Landing Zone ◽

End Point ◽

Male Patients ◽

Long Term Mortality

We aimed to investigate whether sex differences influence the clinical outcomes of patients who undergo thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We retrospectively analyzed a prospectively maintained single-center cohort of patients with TBAD who underwent TEVAR between January 2010 and June 2017. We evaluated the in-hospital and long-term mortality and composite end point. Of the 913 patients, 793 (86.8%) were male and 120 (13.1%) were female. Compared to male patients, the female patients were older, more likely to have diabetes mellitus, but less likely to smoke or have hypertension. The proximal landing zone in 0 and 1 was higher in male patients ( P = .023), who were more likely to require an aortic arch bypass. Endoleak, delirium, and ICU stay after stent-graft implantation were also more frequent in men. Sex factor was not associated with in-hospital or long-term mortality or the composite end point in the multivariable regression analyses and Cox regression model. The mean estimated survival time was similar between males and females (2462.9 ± 141.2 vs 2804.1 ± 117.4 days, P = .167) in the propensity score–matched cohort. Despite distinct characteristics between sex, there was no sex-related difference in long-term clinical outcomes after TEVAR for TBAD.

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Radiation Risk Assessment in Patients for Chest CT Diagnostics of COVID-19

Medical Radiology and radiation safety ◽

10.12737/1024-6177-2021-66-2-59-66 ◽

2021 ◽

Vol 66 (2) ◽

pp. 59-66

Author(s):

E. Matkevich

Keyword(s):

Older Persons ◽

Radiation Risk ◽

Chest Ct ◽

Risk Indicators ◽

Radiation Doses ◽

Diagnostic Center ◽

Adolescents And Adults ◽

Male Patients ◽

Effective Radiation

Purpose: To assess effective radiation doses for chest CT for the diagnosis of COVID-19 and calculate the radiation risk of the effects of this exposure. Material and methods: We analyzed the results of 1003 CT examinations of the chest performed in patients (6.2 %‒children 12–14 years, 15.3 %‒adolescents 15–19 years, 60.1 %‒adults 20–64 years, 18.4 %‒older persons 65 years and older) with suspected COVID-19 during one week in October 2020 in the city diagnostic center. In each group, the average effective dose (ED, mSv) was calculated. Results: The average ED values and confidence intervals (P=0.05) for patients with a single CT scan were: in children 2.59±0.19 mSv, in adolescents 3.23±0.17 mSv, in adults 3.43±0.08 mSv, in older persons 3.28±0.19 mSv. The maximum radiation risk indicators were observed in groups of children (24.1×10-5) and adolescents (23.3×10-5). For adult patients the means risk was 14.4×10-5. In groups of women radiation risk was 1.3–2.3 twice as high, as in male patients. The risk values in children, adolescents and adults are in the range 10×10-5 – 100×10-5 (low), for the older patients were 2.6×10-5 (very low). Conclusion: Because of the study established effective radiation doses for chest CT of patients with the diagnosis of COVID-19 and the radiation risk for 1-3 times chest CT by age and sex of patients was calculated. It was found that the radiation risk for single, double and triple chest CT for patients under 65 is low, 65 and older is very low. Taking into account the radiation risk during CT is necessary to reduce the long-term consequences of radiation exposure on the population.

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The evaluation of long-term screw pull-out rates following posterior thoracolumbar fusion surgery with short and thin pedicle screws

Romanian Neurosurgery ◽

10.33962/roneuro-2019-033 ◽

2019 ◽

pp. 178-182

Author(s):

Umit Kocaman ◽

Hakan Yilmaz

Keyword(s):

Pedicle Screws ◽

Fusion Surgery ◽

Pull Out ◽

Transpedicular Screw ◽

Thoracic Pedicle Screws ◽

Pedicle Length ◽

Neurocentral Junction ◽

Male Patients ◽

Lumbar Pedicle

Background. The aim of this study was to evaluate screw pull-out rates after fusion operations with short and thin pedicle screws.Methods. A total of 200 posterior lumbar and thoracolumbar fusion operations performed at our clinic with short and thin pedicle screws (5.5x35 mm) were retrospectively evaluated. The patients were assessed with computed tomography postoperatively on the day of surgery and at the 6th month. Single groove retraction of the transpedicular screw was evaluated as pull-out. The results were evaluated by the 'number of pull-out cases / total number of cases' and also the 'total number of pull-out screws / total number of screws used' ratios. Results. There were 112 (56%) female and 88 (44%) male patients with a mean age of 58 years. The total number of screws used in the 200 cases was 1188. There were 88 (7.4%) thoracic pedicle screws, 1056 (88.9%) lumbar pedicle screws and 44 (3.7%) sacral pedicle screws used. No pull-out was found in the control CTs taken postoperatively. Left side T11 and T12 pull-out was observed in one case and left L4 pull-out was observed in another case in the control CTs taken at the postoperative 6th month. Pull-out was observed in 2 (1%) of the 200 cases and 3 (0.25%) of the 1188 screws.Conclusions. All the short and thin pedicle screws used had passed the pedicle length and neurocentral junction. The use of a 5.5x35 mm screws in fusion operations is less invasive than using longer and thicker screws while the pull-out rates may be similar.

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Excisional lipectomy versus liposuction in HIV-associated lipodystrophy

Archives of Plastic Surgery ◽

10.5999/aps.2020.02285 ◽

2021 ◽

Vol 48 (6) ◽

pp. 685-690

Author(s):

Natalie Barton ◽

Ryan Moore ◽

Karthik Prasad ◽

Gregory Evans

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Primary Treatment ◽

Highly Active ◽

Number Of Patients ◽

Immunodeficiency Virus ◽

Fat Redistribution ◽

Successful Removal ◽

Male Patients ◽

Haart Therapy

Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy.Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed.Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation.Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.

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Long-term postoperative results of the hautmann ileal orthotopic neobladder reconstruction after radical cystoprostatectomy of bladder cancer

Health of Man ◽

10.30841/2307-5090.4(63).2017.123639 ◽

2017 ◽

Vol 0 (4(63)) ◽

pp. 113-115

Author(s):

A. Fetahu ◽

Xh. Bytyçi ◽

F. Tartari ◽

F. Veselaj ◽

Xh. Çuni ◽

...

Keyword(s):

Bladder Cancer ◽

Orthotopic Neobladder ◽

Postoperative Results ◽

Radical Cystoprostatectomy

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Impact of age on early outcomes and long-term survival of patients undergoing aortic repair with Stanford A dissection

Perfusion ◽

10.1177/0267659118786332 ◽

2018 ◽

Vol 33 (8) ◽

pp. 687-695 ◽

Cited By ~ 1

Author(s):

Julia Merkle ◽

Anton Sabashnikov ◽

Carolyn Weber ◽

Georg Schlachtenberger ◽

Johanna Maier ◽

...

Keyword(s):

Surgical Repair ◽

Age Groups ◽

Term Outcome ◽

Term Survival ◽

Long Term Outcome ◽

Long Term Survival ◽

Cerebrovascular Events ◽

Short And Long Term ◽

Male Patients

Objectives: Stanford A acute aortic dissection (AAD) is a life-threatening emergency, typically occurring in older patients and requiring immediate surgical repair. The aim of this study was to evaluate early outcome and short- and long-term survival of patients under and above 65 years of age. Methods: Two hundred and forty patients with Stanford A AAD underwent aortic surgical repair from January 2006 to April 2015 in our center. After statistical analysis and logistic regression analysis, Kaplan-Meier survival estimation was performed, with up to 9-year follow-up, comprising patients under and above 65 years of age. Results: The proportion of patients above 65 years of age suffering from Stanford A AAD was 50% (n=120). The group of patients above 65 years of age compared to the group under 65 years of age showed statistically significant differences in terms of higher odds ratios (OR) for hypertension (p=0.012), peripheral vascular disease (p=0.026) and tachyarrhythmia absoluta (p=0.004). Patients over 65 years of age also showed significantly poorer short- and long-term survival. Our subgroup analysis revealed that male patients (Breslow p=0.001, Log-Rank p=0.001) and patients suffering with hypertension (Breslow p=0.003, Log-Rank p=0.001) were reasonable for these results whereas younger and older female patients showed similar short- and long-term outcome (Breslow p=0.926, Log-Rank p=0.724). After stratifying all patients into 4 age groups (<45; 55-65; 65-75; >75years), short-term survival of the patients appeared to be significantly poorer with increasing age (Breslow p=0.026, Log-Rank p=0.008) whereas long-term survival of patients free from cerebrovascular events (Breslow p=0.0494, Log-Rank p=0.489) remained similar. Conclusions: All patients referred to our hospital for repair of Stanford A AAD with higher age had poorer short- and long-term survival, caused by male patients and patients suffering from hypertension, whereas survival of women and survival free from cerebrovascular events of the entire patient cohort was similar, irrespective of age.

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Surgical management of sacral meningeal cysts by obstructing the communicating holes with muscle graft

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2998-x ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Kai Yang ◽

Huiren Tao ◽

Chaoshuai Feng ◽

Jiawei Xu ◽

Chunguang Duan ◽

...

Keyword(s):

Cyst Wall ◽

Simple Method ◽

Muscle Graft ◽

Meningeal Cyst ◽

Dural Sac ◽

Neurological Score ◽

Male Patients ◽

Meningeal Cysts

Abstract Background The surgical indication and treatment of sacral meningeal cyst have not been well established and current methods are usually accompanied by complications and recurrence. The aim of this study is to discuss the treatment of symptomatic sacral meningeal cyst, by investigating the surgical results of our surgically treated patients, and minimize the complications and recurrence. Methods We retrospectively reviewed all patients with symptomatic sacral meningeal cysts who were surgically treated by a single surgeon in the same institution from 2002 to 2017. All patients underwent the same operation by incising the cyst wall and obstructing the communicating hole with muscle graft, while the cyst wall was left untreated instead of resected or imbricated. The obstruction was verified by doing a Valsalva-like maneuver. The preoperative symptoms and signs, and the outcomes at most recent follow-up were rated and compared by Neurological Scoring System. Results A total of 18 patients (7 male patients and 11 female patients, average age 42.3 years) were followed up for an average of 51.7 months. All patients had communicating holes linking the cysts and the dural sacs. The average preoperative neurological score was 19.7 ± 2.2, and it was improved to 23.2 ± 2.8 at the most recent follow-up (p < 0.01). Conclusions The sacral meningeal cyst originated from the communication with the dural sac. Surgical treatment of symptomatic sacral meningeal cysts can yield a long-term resolution of the appropriately selected patient’s symptoms. Obstructing the communicating hole with muscle graft is an effective and simple method to obliterate the cyst. The incised cyst wall can be left untreated instead of resected or imbricated.

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