scholarly journals O24 10 YEARS PARTICIPATING IN THE HERNIAMED-REGISTRY: REFLECTING ON RESULTS OF THE PAST HELPS US TO SHAPE THE FUTURE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Franz Mayer ◽  
Michael Lechner ◽  
Ana Gabersek ◽  
Reinhard Bittner ◽  
Klaus Emmanuel
Keyword(s):  
Demographic Data ◽  
Surgical Techniques ◽  
Recurrent Hernia ◽  
Wound Complications ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
The Past ◽  
Age Pyramid ◽  
Voluntary Basis

Abstract Aim Between 01/2011 and 12/2020 5,068 AWR-patients at our department (tertiary referral center) – 884 (17.4%) incisionals. Over this 10-years period considerable changes (patients characteristics, surgical techniques, results) were analyzed. Material and Methods Herniamed® offers an internet-based registry-platform to document all kinds of abdominal wall repairs on a voluntary basis since 2009. Demographic data, interventional details and outcomes are documented using the EHS-classification-system. Follow-up is standardized and sheduled for 10 years. Results Up to 54.7% of patients (in 2020) show at least one risk factor (diabetes, smoking ….), in contrast to the age pyramid patients >70 years are decreasing (47.2% in 2011 down to 29.3% in 2020), share of ASA III/IV is initially increasing (up to 42.9% in 2017) with a constant decrease after 2017 to 25.3% in 2020. Emergent cases are increasing (6.9% in 2011 up to 10.8% in 2019). Recurrent hernia repairs stays almost constant at median 21.7%. After 2015 we decided – for various reasons - not to routinely apply the laparoscopic IPOM-technique (with an interim ratio of up to 46.2%) – with a post-OP complication rate of median 23.3% anymore. From 2016 onwards we performed an increasing number of „other techniques“ (E-MILOS, E-TEP, ….) up to 36% in 2020 instead. Conclusions By analysing trends we recognized that patients show increasing numbers of risk factors and ASA-scores which led us to implement a prehabilitational strategy in clinical routine. However rate of post-OP complication is still high representing AWR as demanding in many aspects. A temporary cessation of MIS did not led to an extensive increase in post-OP wound complications.

Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003–2012: Results of the French National Network Survey, AES-RAISIN

2015 ◽  
Vol 36 (8) ◽  
pp. 963-968 ◽  
Author(s):  
N. Floret ◽  
O. Ali-Brandmeyer ◽  
F. L’Hériteau ◽  
C. Bervas ◽  
S. Barquins-Guichard ◽  
...  
Keyword(s):  
Body Fluid ◽  
Sharp Decrease ◽  
Healthcare Personnel ◽  
Significant Drop ◽  
Healthcare Facilities ◽  
National Network ◽  
The Past ◽  
Personnel Safety ◽  
Voluntary Basis

OBJECTIVETo assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities.METHODRetrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008–12).FINDINGSReported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012.CONCLUSIONOf the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.Infect. Control Hosp. Epidemiol. 2015;36(8):963–968

scholarly journals Functional Outcomes and MRI Results Following Knotless Repair of Acute Achilles Tendon Ruptures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Brian D. Steginsky ◽  
Mallory Suhling ◽  
Eric Giza ◽  
Christopher D. Kreulen ◽  
B. Dale Sharpe ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Achilles Tendon ◽  
Functional Outcomes ◽  
Tendon Repair ◽  
Surgical Techniques ◽  
Wound Complications ◽  
Distal Stump ◽  
Achilles Tendon Repair ◽  
Tendon Ruptures

Category: Ankle; Sports Introduction/Purpose: The surgical techniques for primary repair of acute Achilles tendon ruptures have evolved from large open incisions to mini-open and percutaneous techniques. Studies have demonstrated that lesser invasive surgical techniques may reduce the risk of post-operative wound complications. Knotless surgical repair of acute Achilles tendon ruptures can be performed through a mini-incision, but still permits a robust re-approximation of the tendon stumps and decreases suture burden through distal anchor fixation in the calcaneus. However, stress shielding and subsequent tendinosis of the distal tendon stump is a theoretical concern with this surgical technique. We hypothesize that our surgical technique allows for a durable repair through a minimally invasive approach, permitting a safe and accelerated rehabilitation protocol, excellent functional outcomes, and absence of distal stump tendinosis. Methods: A multicenter retrospective chart review was performed to identify all patients that underwent primary Achilles tendon repair using a knotless surgical technique with a minimum of one-year follow-up from three orthopedic foot and ankle surgeons’ practices. Exclusion criteria included: age <18, chronic Achilles tendon ruptures (>4 weeks), insertional Achilles tendon ruptures, revision Achilles surgery, peripheral neuropathy, and systemic inflammatory disease. All patients were contacted by phone and asked to return to the office for an MRI, clinical examination, and completion of functional outcome questionnaires. The primary outcome measure was the validated Achilles Tendon Total Rupture Score (ATRS). Secondary outcomes included the Visual Analog Score (VAS), postoperative complications, ankle range of motion, calf circumference, and single-heel rise. MRI was used to assess tendon continuity and healing, tendinosis, muscle atrophy, and bone marrow edema/stress fracture associated with anchor fixation in the calcaneus. MRI interpretation was performed by a single, blinded musculoskeletal radiologist. Results: Forty-three patients were identified with acute Achilles tendon ruptures. There were 36 patients (36/43, 84%) who underwent knotless Achilles tendon repair and agreed to participate in the study. The average time to clinical follow-up was 23.5 months (SD±16.3). The mean postoperative ATRS was 84.6 (SD±19.7). There was no significant difference in calf circumference (p=0.22), dorsiflexion (p=0.07), and plantarflexion (p=0.11) between the unaffected and surgical extremity at latest follow-up. One patient (1/36, 2.8%) experienced a re-rupture. There were no wound complications or neuritis. MRI was obtained in 26 patients (26/36, 72.2%) at an average of 17.5 months (SD±10.1). There were no MRI findings of distal stump tendinosis or calcaneal stress fractures. Thirty-two patients (32/36, 88.8%) returned to the same athletic activities one-year after surgery. Conclusion: There is paucity in the literature on functional outcomes following knotless Achilles tendon repair. In this multicenter study, we found that validated functional outcome scores and return to activity were similar to historical controls, with a low rate of surgical complications. MRI obtained in twenty-six patients (72.2%) at 17.5 months demonstrated an intact tendon without distal tendon stump stress shielding or calcaneal stress fracture. The knotless Achilles tendon repair is a unique surgical technique, minimizing suture burden and postoperative complications, while offering excellent functional outcomes and return to activity at two-year follow-up. The excellent clinical outcomes are corroborated by MRI.

Anatomically Contoured Anterior Plating for Isolated Tibiotalar Arthrodesis: A Systematic Review

2017 ◽  
Vol 10 (4) ◽  
pp. 352-358 ◽  
Author(s):  
Nicholas Kusnezov ◽  
John C. Dunn ◽  
Logan R. Koehler ◽  
Justin D. Orr
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Wound Complications ◽  
Posttraumatic Arthritis ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Tibiotalar Arthrodesis ◽  
Anterior Plating

Introduction. We performed a systematic review of the published literature to characterize patient demographic, surgical techniques, and functional outcomes to elucidate the complication and revision rates following isolated tibiotalar arthrodesis with anatomically contoured anterior plating. Methods. A comprehensive literature search was performed. Inclusion criteria were peer-reviewed studies in English, after 1990, at least 10 patients, and reporting clinical outcomes following contoured anterior plating and with follow-up of at least 80% and 1 year. Primary outcomes were fusion rate, time to fusion, return to activities, satisfaction, and functional outcome scores. Complication rates, reoperation, and revision were also extracted. Results. Eight primary studies with 164 patients met the inclusion criteria. The average sample size was 21 ± 10.0 patients and average age was 49.2 years with 61.6% male. Posttraumatic arthritis (49.4%) was the most common operative indication, followed by primary osteoarthrosis (18.9%). The average follow-up was 21.1 months. At this time, 97.6% of patients went on to uneventful union at a weighted average time of 18.7 weeks postoperatively. AOFAS scores improved significantly ( P < .05). 25% complication rate was reported with wound complication (7.9%) and hardware irritation (6.7%) most common. Overall, 21.3% of patients underwent reoperation; 4 for revision arthrodesis following nonunion. Conclusion. Isolated tibiotalar arthrodesis utilizing anatomically contoured anterior plating demonstrates excellent clinical and functional outcomes at short-term follow-up. Overall, 97.6% of patients went on to fusion and functional outcomes consistently improved following surgery. Furthermore, while one-quarter of patients experienced complications, wound complications were relatively uncommon and less than one-quarter of these required surgical intervention. Levels of Evidence: Level IV: Systematic Review

scholarly journals Changing indications and surgical techniques for corneal transplantation between 2004 and 2009 at a tertiary referral center

2012 ◽  
Vol 19 (3) ◽  
pp. 323 ◽  
Author(s):  
Sepehr Feizi ◽  
MohammadA Javadi ◽  
Farid Karimian ◽  
AliR. B. Rafie ◽  
Mohammad Zare ◽  
...  
Keyword(s):  
Corneal Transplantation ◽  
Surgical Techniques ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center

Primary focal cryosurgery of the prostate: Long-term clinical and biochemical outcomes in a large cohort at a tertiary referral center.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 114-114
Author(s):  
Jamie Sungmin Pak ◽  
Philippa J. Cheetham ◽  
Aaron Katz ◽  
Sven Wenske
Keyword(s):  
Cancer Control ◽  
Median Number ◽  
Primary Treatment ◽  
Consecutive Series ◽  
Primary Therapy ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Psa Nadir

114 Background: Modern primary focal cryosurgery (PFC) has emerged as a primary therapy option for localized and minimal low-risk prostate cancer (PCa), achieving good local cancer control and survival outcome. The aim of this analysis was to report on the experience of PFC in our tertiary referral center in the management of localized PCa. Methods: We identified a consecutive series of patients that underwent PFC for localized PCa at our institution between 8/2000 and 1/2014. Demographics, PSA levels and Gleason scores before primary treatment and at time of recurrence were assessed; BDFS, OS, and DSS were assessed. BCR was defined by the Phoenix (PD) and Stuttgart Definitions (SD). Results: A total of 126 patients were included in the analysis, with a median follow-up of 40.3 (0.8-116, IQR 41) months. Median age was 73.5 (range 45-92, IQR 9) years. Median initial serum PSA level was 6.0 (1-44.5, IQR 3) ng/ml. Median primary and secondary Gleason score on initial biopsy was 3 (3-5, IQR 1) with a median sum of 6 (6-10, 1), and 15% (2-95%, IQR 0) of biopsy tissue involved with cancer. Median number of biopsy cores was 12 (2-32), with a median of 1 (1-12, IQR 1) core affected by cancer. Median PSA nadir post-treatment was 1.3 (0.1-13.1, IQR 2) ng/ml. According to PD and SD, 24 and 37 patients had BCR after a median of 14.9 (3.4-91.3, IQR 17) and 13.0 (2.9-90.3, IQR 11) months. Overall 4-year-BDFS was 83% and 73% by PD and SD, respectively. 5-year OS and DSS was 95%, and 99.2%. Of patients that met BCR criteria, almost 25% were proven to be negative on biopsy, confirming over-estimation of failures. Patients that recurred had significantly higher initial median PSA levels (8.5 vs. 5.8 ng/ml; p<0.01) and PSA-nadir (2.1 vs. 1.0 ng/ml; p<0.05). Conclusions: Our analysis confirms PFC being a good option with low rate of morbidities for patients with localized PCa, with excellent BDFS and DSS at a long follow-up of 40 months. Controversy exists regarding criteria of BCR-definitions after focal therapies. More stringent definitions, such as the SD, especially in a focal cryosurgery setting, significantly over-estimate failure rates, and prostate biopsy seems to be the only reliable means to assess for recurrence at this point.

scholarly journals Higher Risk of Aggressive Pancreatic Neuroendocrine Tumors in MEN1 Patients With MEN1 Mutations Affecting the CHES1 Interacting MENIN Domain

2014 ◽  
Vol 99 (11) ◽  
pp. E2387-E2391 ◽  
Author(s):  
Detlef K. Bartsch ◽  
Emily P. Slater ◽  
Max Albers ◽  
Richard Knoop ◽  
Brunhilde Chaloupka ◽  
...  
Keyword(s):  
Multiple Endocrine Neoplasia ◽  
Multiple Endocrine Neoplasia Type ◽  
Clinical Phenotype ◽  
Tertiary Referral ◽  
Course Of Disease ◽  
Tertiary Referral Center ◽  
Checkpoint Kinase 1 ◽  
Related Mortality

Context: Sixty to 80% of multiple endocrine neoplasia type 1 (MEN1) patients develop pancreatic neuroendocrine neoplasias (pNENs), which reveal an aggressive behavior in 10%-20% of patients. Causative MEN1 mutations in the interacting domains of the encoded Menin protein directly alter its regulation abilities and may influence the phenotype. Objective: The objective of the study was the evaluation of an association between MEN1 mutations in different interacting domains of Menin and the phenotype of pNENs. Design: This was a retrospective analysis of a prospectively collected cohort of 71 genetically confirmed MEN1 patients at a tertiary referral center. Main Outcome Measures: Analysis of patients' characteristics and clinical phenotype of pNENs regarding the mutation type and its location in Menin interacting domains was measured. Results: Sixty-seven patients (93%) developed pNENs after a median follow-up of 134 months. Patients with mutations leading to loss of interaction (LOI) with the checkpoint kinase 1 (CHES1) interacting domain codons (428–610) compared with patients with mutations resulting in LOI with other domains (eg, JunD, Smad3) had significantly higher rates of functioning pNENs (70% vs 34%), malignant pNENs (59% vs 16%), and aggressive pNENs (37% vs 9%), respectively. Patients with CHES1-LOI also had an increased pNEN-related mortality (20% vs 4.5%). Neither gender, age, nor the ABO blood types were associated with the phenotype of pNENs. Conclusions: MEN1 patients with MEN1 mutations leading to CHES1-LOI have a higher risk of malignant pNENs with an aggressive course of disease and disease-related death.

Postnatal outcomes of infants with gastroschisis: a 5-year follow-up in a tertiary referral center in Brazil

2015 ◽  
Vol 29 (3) ◽  
pp. 418-422 ◽  
Author(s):  
Natália Silva Carvalho ◽  
Talita Micheletti Helfer ◽  
Priscila de Oliveira Serni ◽  
Ohanna Ana Terasaka ◽  
Tatiane Boute ◽  
...  
Keyword(s):  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center

scholarly journals Characteristics, Treatment, Outcomes, and Survival in Neuroendocrine G1 and G2 Pancreatic Tumors: Experiences From a Single Tertiary Referral Center

2021 ◽  
Vol 12 ◽  
Author(s):  
Jan Calissendorff ◽  
Freja Bjellerup-Calissendorff ◽  
Robert Bränström ◽  
C. Christofer Juhlin ◽  
Henrik Falhammar
Keyword(s):  
Treatment Outcomes ◽  
Metastatic Disease ◽  
Progressive Disease ◽  
Pancreatic Tumors ◽  
Proliferation Index ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Initial Surgery ◽  
Tertiary Center

PurposeNeuroendocrine tumors of the pancreas (Pan-NETs) are usually hormonally inactive with a capacity to metastasize. Since Pan-NETs are rare, more knowledge is needed.MethodsWe reviewed all patients’ medical files with Pan-NET treated at a tertiary center (2006-2019). Grade 1 (G1) and grade 2 (G2) tumors were compared. The latter group was subdivided arbitrarily based on proliferation index into G2a (3-9.9%) and G2b (10-19.9%).ResultsWe found 137 patients (76 females, 61 males; G1 n=66, G2 n=42), the median age at diagnosis 61 years (interquartile range (IQR) 50–71), and tumor size 2 cm (1.3–5 cm). The initial surgery was performed in 101 patients. The remaining (n=36) were followed conservatively. Metastatic disease was evident in 22 patients (16%) at diagnosis while new lesions developed in 13 out of 22 patients (59%). In patients without previous metastatic disease, progressive disease was discovered in 29% of G1 vs. 55% of G2 patients (P=0.009), 47% of G2a vs. 75% of G2b patients (NS). Survival was poorer in patients with metastasis at diagnosis vs. those with local disease (P&lt;0.001). During follow-up of 74 months, Pan-NET related death was found in 10 patients. Survival was not different between G1 vs. G2 or G2a vs. G2b, or if tumors were functional. Size ≤2 cm was associated with a better outcome (P=0.004). During the follow-up of small tumors (≤2 cm, n=36) two were resected.ConclusionIn small non-functional Pan-NETs, active surveillance is reasonable. Progressive disease was more common in G2, but survival was similar in G1, G2 and between G2 subgroups. Survival was poorer in patients with metastasis at diagnosis.

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