scholarly journals 168 Interprosthetic Fractures of The Femur: A Literature Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Marzano ◽  
V Pace ◽  
F Milazzo ◽  
A Caraffa ◽  
P Antinolfi
Keyword(s):  
Femur Fracture ◽  
Classification Systems ◽  
Surgical Approaches ◽  
High Morbidity ◽  
Complication Rates ◽  
Management Guidelines ◽  
Stress Risers ◽  
Pubmed Database ◽  
Common Diagnosis ◽  
Surgical Options

Abstract Increasing age expectations and number of joint replacement procedures have made interprosthetic femoral fractures (IFF) a progressively more common diagnosis and a challenge for surgeons. A gold standard and universally accepted classifications and guidelines do not exist yet. Customized structured electronic searches performed in PubMed database. Relevant key terms: IFF, classification interprosthetic fracture, peri-implant femoral fracture, biomechanics interprosthetic femur fracture, radiographic femur fracture, risk factor IFF. 42 articles finally included (up to 2019). High morbidity and mortality linked to IFF. Standardised classifications, management guidelines and surgical approaches are not available yet. Periprosthetic classification systems are still utilized even if not entirely appropriate. High rate of failure is related to thinner cortical bone, larger medullary canals and variable stresses depending on the distance among implants. High complication rates in all studies. Stress risers and implant stability based on fracture patterns and stress forces. Several surgical options with no uniformity. Less invasive surgical procedures are associated to reduction of metalwork failure rate, better preservation of vascularization and better functional-clinical outcomes. Lack of specific classification systems and management guidelines. Several surgical options are available with no uniformity of results. Attention to stress risers and preservation of bone stock and vascularization are key aspects for better results.

Sacrospinous hysteropexy – an alternative in primary surgical treatment of apical compartment prolapse

2021 ◽  
Vol 86 (3) ◽  
pp. 200-204
Author(s):  
Prokop Homola ◽  
◽  
Germund Hensel ◽  
Milan Košťál
Keyword(s):  
Surgical Treatment ◽  
Pelvic Organ Prolapse ◽  
Operation Time ◽  
Pelvic Organ ◽  
Complication Rates ◽  
Female Population ◽  
Sacrospinous Hysteropexy ◽  
Pubmed Database ◽  
Common Diagnosis ◽  
Apical Compartment

Summary Objective: To present a surgical treatment of pelvic organ prolapse and its outcomes according to the literature. Methods: PubMed database search. Conclusion: Pelvic organ prolapse is a common diagnosis with prevalence around 40% of female population. Vaginal delivery, especially with levator ani trauma, increasing age and obesity are the basic risk factors. Native tissue repair is a possible surgical treatment. Unfortunately, concomitant hysterectomy is still a very common procedure. It is established that uterus plays a passive role in pelvic organ prolapse. Sparing of the uterus keeps the original fixation structures and compartments intact and provides a solid tissue to anchor the stitches. Patients with benign and malign uterine diseases cannot have their uterus spared. In sacrospinous hysteropexy, nonabsorbable sutures are passed through the namesaked ligament on one or both sides to elevate the uterus. Several studies and their metaanalyses show comparable anatomical and functional outcomes with shorter operation time, decreased blood loss, faster recovery and lower complication rates in comparison with hysterectomy and uterosacral ligament fixation. In a prospective randomized control trial, sacrospinous hysteropexy provides significantly lower reoperation rate for apical compartment prolapse in a long-term follow-up. It is a safe and effective procedure for patients who wish to keep their uterus in place. Sacrospinous hysteropexy is an alternative in primary surgical treatment of pelvic organ prolapse.

Malignant Pleural Effusion: Still a Long Way to Go

2019 ◽  
Vol 14 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Fausto Meriggi
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
English Language ◽  
Metastatic Cancer ◽  
Primary Tumour ◽  
Clinical Problem ◽  
Therapeutic Options ◽  
High Morbidity ◽  
Sclerosing Agents ◽  
Pubmed Database

Background:Malignant pleural effusion, which is a common clinical problem in patients with cancer, may be due to both primary thoracic tumours or to a metastatic spread in the chest and constitutes the first sign of disease in approximately 10% of patients. Almost all cancers can potentially produce a pleural effusion. The presence of malignant tumour cells in the pleural fluid is generally indicative of advanced disease and is associated with high morbidity and mortality with reduced therapeutic options. Dyspnoea during mild physical activity or at rest is generally the typical sign of restrictive respiratory failure. </P><P> Methods: This is a systematic review of all the main articles in the English language on the topic of malignant pleural effusion and reported by the Pubmed database from 1959 to 2018. I reviewed the literature and guidelines with the aims to focus on what is known and on future pathways to follow the diagnosis and treatment of malignant pleural effusions.Results:The main goal of palliation of a malignant pleural effusion is a quick improvement in dyspnoea, while thoracentesis under ultrasound guidance is the treatment of choice for patients with a limited life expectancy or who are not candidates for more invasive procedures such as drainage using an indwelling small pleural catheter, chemical pleurodesis with sclerosing agents, pleurectomy or pleuro-peritoneal shunt.Conclusion:Despite progress in therapeutic options, the prognosis remains severe, and the average survival is 4-9 months from the diagnosis of malignant pleural effusion. Moreover, mortality is higher for patients with malignant pleural effusion compared with those with metastatic cancer but no malignant pleural effusion. Therefore, the prognosis of these patients primarily depends on the underlying disease and the extension of a primary tumour. This review focuses on the most relevant updates in the management of malignant pleural effusion.

scholarly journals Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 710
Author(s):  
Abel Botelho Quaresma ◽  
Fernanda da Silva Barbosa Baraúna ◽  
Fábio Vieira Teixeira ◽  
Rogério Saad-Hossne ◽  
Paulo Gustavo Kotze
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Randomized Studies ◽  
Pubmed Database ◽  
Increased Risk ◽  
The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

scholarly journals Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

2021 ◽  
Author(s):  
Istvan Bence Balint ◽  
Ferenc Csaszar ◽  
Krisztian Somodi ◽  
Laszlo Ternyik ◽  
Adrienn Biro ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Surgical Procedures ◽  
Risk Level ◽  
Jejunal Mucosa ◽  
Complication Rates ◽  
Pubmed Database ◽  
Significant Difference ◽  
Weight Loss Outcomes ◽  
Jejunal Bypass

Abstract Purpose Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. Methods A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. Results A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): −0.03 and confidence interval (CI): −0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01–0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: −0.03, CI: −0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74–1.59 for BMI changes). Conclusion Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors’ hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.

scholarly journals Is it a matter of time? The effect of transfer time on femur fracture outcomes

2021 ◽  
Vol 6 (1) ◽  
pp. e000701
Author(s):  
Leah E Larson ◽  
Melissa L Harry ◽  
Paul K Kosmatka ◽  
Kristin P Colling
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Femur Fracture ◽  
Fracture Repair ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Transfer Time ◽  
Femur Fractures ◽  
Initial Hospital ◽  
Level 1

BackgroundTrauma systems in rural areas often require longdistance transfers for definitive care. Delays in care, such as delayed femurfracture repair have been reported to be associated with poorer outcomes, butlittle is known about how transfer time affects time to repair or outcomesafter femur fractures.MethodsWe conducted a retrospective review of all trauma patients transferred to our level 1 rural trauma center between May 1, 2016-April 30, 2019. Patient demographics and outcomes were abstracted from chart and trauma registry review. All patients with femur fractures were identified. Transfer time was defined as the time from admission at the initial hospital to admission at the trauma center, and time to repair was defined as time from admission to the trauma center until operative start time. Our outcome variables were mortality, in-hospital complications, and hospital length of stay (LOS).ResultsOver the study period1,887 patients were transferred to our level 1 trauma center and 398 had afemur fracture. Compared to the entire transfer cohort, femur fracture patientswere older (71 versus 57 years), and more likely to be female (62% versus 43%).The majority (74%) of patients underwent fracture repair within 24hours. Delay in fracture fixation >24 hours wasassociated with increased length of stay (5 days versus 4 days; p<0.001),higher complication rates (23% versus 12%; p=0.01), and decreased dischargehome (19% vs. 32%, pp=0.02), but was not associated with mortality (6% versus5%; p=0.75). Transfer time and time at the initial hospital were not associatedwith mortality, complication rate, or time to femur fixation.DiscussionFixation delay greater than 24 hours associated with increased likelihood of in-hospital complications, longer length of stay, and decreased likelihood of dischargehome. Transfer time not related to patient outcomes or time to femur fixation.Level of evidenceLevel III; therapeutic/care management.

scholarly journals Prescribing Empiric Antibiotics for Febrile Neutropenia: Compliance with Institutional Febrile Neutropenia Guidelines

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 83 ◽  
Author(s):  
Doaa Naeem ◽  
Majed Alshamrani ◽  
Mohammed Aseeri ◽  
Mansoor Khan
Keyword(s):  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Bacterial Infections ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Management Guidelines ◽  
Empiric Antibiotics ◽  
Inappropriate Use ◽  
Common Diagnosis ◽  
The Mean

Background: Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to assess compliance with FN management guidelines and to describe the pattern of bacterial infections. Method: We conducted a cross-sectional study on all adult cancer patients admitted with FN. Data were collected from electronic medical records between January and December 2014. Results: One hundred FN episodes met the study inclusion criteria. The mean age of the patients was 41 ± 17 years; 52% (52 patients) were women. The most common diagnosis was lymphoma (33%). In terms of compliance to institutional FN guidelines, 55% of patients received guideline non-compliant treatment. The most common non-compliant treatment was incorrect amikacin dosing in 31% of patients, followed by incorrect vancomycin dosing in 20%, incorrect piperacillin/tazobactam dosing in 19%, inappropriate use of carbapenems in 18%, and non-compliant vancomycin use in 12% of patients. Bacterial isolates were only observed in 19% of the FN episodes. Among these 19 episodes of FN, Gram-negative pathogens were predominant and were identified in 74% of the episodes, followed by Gram-positive pathogens in 16% and polymicrobial pathogens in 10%. The mean time to defervescence was 2.21 ± 2 days. Conclusion: Our study concluded that there was a high percentage of non-compliance with our institutional FN management guidelines. We recommend following appropriate empiric antibiotic doses and indications as per institutional guidelines.

scholarly journals Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

2019 ◽  
Vol 64 (2) ◽  
pp. 131
Author(s):  
Rodrigo Salmeron de Toledo Aguiar ◽  
Guilherme Brasileiro de Aguiar ◽  
Rafael Gomes dos Santos ◽  
André Freitas Nunes ◽  
Renan Maximilian Lovato ◽  
...  
Keyword(s):  
Surgical Management ◽  
Intracranial Aneurysms ◽  
Surgical Techniques ◽  
Vascular Lesion ◽  
High Morbidity ◽  
Good Efficiency ◽  
Treatment Techniques ◽  
Pubmed Database ◽  
Surgical Methods ◽  
Ruptured Intracranial Aneurysms

ABSTRACT Introduction: Blister aneurysms are of uncertain pathogenesis and are a vascular lesion located in the brain. Overall, they represent 0.3% - 1.0% of all intracranial aneurysms and 0.9% - 6.5% of ruptured intracranial aneurysms. They are associated with high morbidity and mortality. Even with the first description being from 1969, there is still debate in the literature about which type of treatment is the best: surgical or endovascular. In this review, we focus on the surgical management. Method: The authors performed a review of available surgical techniques used for blood blister-like aneurysms treatment. Pubmed database was used as search source introducing blister-like aneurysm and blister aneurysms as keywords. The most relevant articles and those that focused on surgical treatment techniques were selected. Discussion: The most used surgical methods are clipping, trapping, wrapping and bypass. As main features of each technique, we can highlight clipping with good efficiency, when there is good neck exposure; trapping being employed in ruptured aneurysm; wrapping for avulsion and bypass that promotes vascularization to the distal territory of the aneurysm. Conclusion: The endovascular method has shown to be promising and efficient. However, different surgical techniques are still being employed based on their efficiency when facing certain surgical scenarios.Keywords: Neurosurgery, Subarachnoid hemorrhage, Intracranial aneurysm, Endovascular proceduresRESUMOIntrodução: Aneurismas cerebrais blister-like são lesões vasculares de patogenia incerta. De modo geral, representam 0.3%-1.0% de todos aneurismas intracranianos e 0.9% - 6.5% dos aneurismas intracranianos que rompem. Estão associados a alta morbimortalidade. Mesmo com a primeira descrição sendo de 1969, ainda há debate na literatura sobre qual tipo de tratamento é o melhor: cirúrgico ou endovascular. Nessa revisão, focamos no tratamento cirúrgico. Métodos: Os autores realizaram uma revisão das técnicas cirúrgicas utilizadas para tratamento de aneurismas blister-like. A plataforma Pubmed foi utilizada para a pesquisa das palavras chaves “blister-like aneurysm” e “blister aneurysm”. Os artigos de maior relevância e aqueles que enfatizam as técnicas cirúrgicas foram selecionados. Discussão: Os métodos cirúrgicos empregados são clipagem, trapping, wrapping e bypass. Quanto às características de cada método, podemos salientar a eficácia da clipagem, quanto melhor for a exposição do aneurisma; o uso do trapping em situações de rompimento do aneurisma; wrapping para casos em que houve avulsão do aneurisma e by-pass que promove a vascularização distal ao aneurisma. Conclusão: O método endovascular tem se mostrado promissor e efetivo. No entanto, as diferentes técnicas cirúrgicas ainda são empregadas e defendidas devido a sua eficiência frente certos cenários cirúrgicos.Descritores: Neurocirurgia, Hemorragia subaracnóidea, Aneurisma intracraniano, Procedimentos endovasculares

scholarly journals The role of an anterior approach in the treatment of ankylosing spondylitis–associated cervical fractures: a systematic review and meta-analysis

2021 ◽  
Vol 51 (4) ◽  
pp. E9
Author(s):  
Vaidya Govindarajan ◽  
Jean-Paul Bryant ◽  
Roberto J. Perez-Roman ◽  
Michael Y. Wang
Keyword(s):  
Systematic Review ◽  
Ankylosing Spondylitis ◽  
Anterior Approach ◽  
Meta Analysis ◽  
Neurological Function ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Neurological Improvement ◽  
Cervical Fractures ◽  
Anterior Posterior

OBJECTIVE Cervical fractures in patients with ankylosing spondylitis can have devastating neurological consequences. Currently, several surgical approaches are commonly used to treat these fractures: anterior, posterior, and anterior-posterior. The relative rarity of these fractures has limited the ability of surgeons to objectively determine the merits of each. The authors present an updated systematic review and meta-analysis investigating the utility of anterior surgical approaches relative to posterior and anterior-posterior approaches. METHODS After a comprehensive literature search of the PubMed, Cochrane, and Embase databases, 7 clinical studies were included in the final qualitative and 6 in the final quantitative analyses. Of these studies, 6 compared anterior approaches with anterior-posterior and posterior approaches, while 1 investigated only an anterior approach. Odds ratios and 95% confidence intervals were calculated where appropriate. RESULTS A meta-analysis of postoperative neurological improvement revealed no statistically significant differences in gross rates of neurological improvement between anterior and posterior approaches (OR 0.40, 95% CI 0.10–1.59; p = 0.19). However, when analyzing the mean change in neurological function, patients who underwent anterior approaches had a significantly lower mean change in postoperative neurological function relative to patients who underwent posterior approaches (mean difference [MD] −0.60, 95% CI −0.76 to −0.45; p < 0.00001). An identical trend was seen between anterior and anterior-posterior approaches; there were no statistically significant differences in gross rates of neurological improvement (OR 3.05, 95% CI 0.84–11.15; p = 0.09). However, patients who underwent anterior approaches experienced a lower mean change in neurological function relative to anterior-posterior approaches (MD −0.46, 95% CI −0.60 to −0.32; p < 0.00001). There were no significant differences in complication rates between anterior approaches, posterior approaches, or anterior-posterior approaches, although complication rates trended lower in patients who underwent anterior approaches. CONCLUSIONS The results of this review and meta-analysis demonstrated the varying benefits of anterior approaches relative to posterior and anterior-posterior approaches in treatment of cervical fractures associated with ankylosing spondylitis. While reports demonstrated lower degrees of neurological improvement in anterior approaches, they may benefit patients with less-severe injuries if lower complication rates are desired.

Complications of Intra-articular Calcaneal Fractures in Adults

2016 ◽  
Vol 9 (6) ◽  
pp. 534-542 ◽  
Author(s):  
Christos Koutserimpas ◽  
George Magarakis ◽  
Grigoris Kastanis ◽  
George Kontakis ◽  
Kalliopi Alpantaki
Keyword(s):  
Present Article ◽  
Specific Treatment ◽  
Complication Rates ◽  
Calcaneal Fractures ◽  
Levels Of Evidence ◽  
Proper Management ◽  
Evidence Level ◽  
Pubmed Database ◽  
Prevention Methods ◽  
Complex Injuries

Calcaneal fractures are complex injuries with high complication rates and they can lead to serious disability. The proper management remains controversial and complications may occur regardless of the chosen type of treatment (operative or nonoperative). The present article reviews the studies that are related to the complications of calcaneal fractures. The incidence, the diagnosis, the prevention and the treatment of these complications were researched and analyzed, with the use of PubMed database, abstracts and original articles in English than investigate the etiology. The aim of the article is to discuss the most suitable management of the complications of calcaneal fractures and recommend a specific treatment as well as prevention methods. Levels of Evidence: Level IV

Surgery of pituitary tumours

2011 ◽  
pp. 165-176
Author(s):  
Ian F. Dunn ◽  
Edward R. Laws
Keyword(s):  
Technological Innovation ◽  
Surgical Approach ◽  
Transsphenoidal Surgery ◽  
Transsphenoidal Approach ◽  
Surgical Approaches ◽  
Pituitary Tumours ◽  
Full Spectrum ◽  
Clinical Syndromes ◽  
Surgical History ◽  
Surgical Options

Pituitary tumours have both endocrine and neuro-oncologic sequelae. Secretory tumours may liberate physiological hormones to pathological excess, generating a full spectrum of metabolic aberrations and hallmark clinical syndromes. Other pituitary tumours are endocrinologically inactive and generate instead a variety of compressive phenomena such as pituitary hypofunction and neurological compromise. Although advances continue to be made in the pharmacological and radiotherapeutic management of pituitary tumours, surgery remains the treatment of choice for most of these lesions. Of the available surgical options, the transsphenoidal route is the dominant surgical approach to these tumours. Shaped by the brilliant insight of individual surgeons and technological innovation, transsphenoidal surgery for the sellar and parasellar regions is a fascinating chronicle in surgical history whose evolution continues unabated. We herein review surgical approaches to pituitary tumours, emphasizing the transsphenoidal approach.

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