scholarly journals Outcome Comparison of KTP laser and CO2 laser excision for Laryngeal papillomatosis -- A Systematic Review

2021 ◽  
Author(s):  
Jimin Yang ◽  
Zhongcheng Xie
Keyword(s):  
Systematic Review ◽  
Co2 Laser ◽  
Surgical Techniques ◽  
Ktp Laser ◽  
Laryngeal Papillomatosis ◽  
Recurrence Rates ◽  
Randomized Controlled Studies ◽  
Significant Difference ◽  
Outcome Comparison ◽  
Laser Excision

Background: CO2 laser and the 532-nm potassium titanyl phosphate laser (KTP) were developed to treat Laryngeal papillomatosis (LP); however, the difference in their outcomes remains unclear. Methods: A systematic review was conducted through a comprehensive search of three databases. Results: Overall, the cure rates were 87.25% in the KTP group and 75.98% in the CO2 group (p＜0.05). The complications rates were significantly different between the two groups (p<0.0001). In addition, there was no significant difference between the recurrence rates of the CO2 group and the KTP group (10% vs 9.8%). The risks of bias were 13.1±1.45 and 13.6±1.52 for CO2 group and KTP group respectively, which indicated the fair quality of evidence. Conclusions: The available fair-quality evidence suggested that KTP laser excision may be a better choice for LP. Following evaluations on the benefits of the two surgical techniques with more high-quality randomized controlled studies are needed.

scholarly journals Five Percent Potassium Hydroxide for the Treatment of Anogenital Warts: A Systematic Review and Meta-analysis

2019 ◽  
Vol 53 (2) ◽  
Author(s):  
Shahara Abalos-Babaran ◽  
Jay-V James G. Barit ◽  
Francisca DC. Roa
Keyword(s):  
Systematic Review ◽  
Co2 Laser ◽  
Clearance Rate ◽  
Potassium Hydroxide ◽  
Meta Analysis ◽  
Treatment Modalities ◽  
Comparable Efficacy ◽  
Laser Vaporization ◽  
Anogenital Warts ◽  
Significant Difference

Background and Objectives. Potassium hydroxide (KOH) is effective and safe as treatment of viral dermatoses. No systematic review has been done reporting its efficacy as a treatment for anogenital warts. Methods. A systematic literature search for controlled clinical trials using KOH, any drug or ablative procedure measuring the clearance rate was conducted. Analysis was done using RevMan v5.3 software. Results. Four low quality trials, composed of 197 patients were included but only two qualified for meta-analysis. Two studies compared KOH to cryotherapy while the two other trials compared KOH to intralesional 5-fluorouracil (FU) + salicylic acid (SA) and carbon dioxide (CO2) laser vaporization. The KOH group showed a higher clearance rate compared to cryotherapy (RR= 1.40, P> 0.05, I2=39 %) and no recurrence was noted (RR= 0.17, P> 0.05, I2=0) but the difference is not statistically significant. Isik et al., 2014 and Asadi et al., demonstrated that there was no significant difference among groups receiving KOH, 5-FU+SA and CO2 laser vaporization in the mean lesion count and size at follow up visits. (P > 0.05). Conclusions. Potassium hydroxide has comparable efficacy to the present treatment modalities but well-structured RCTs are needed to further support its use.

A SYSTEMATIC REVIEW OF COMPLICATIONS AND RECURRENCE RATE OF ARTHROSCOPIC RESECTION OF VOLAR WRIST GANGLION

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 475-480 ◽  
Author(s):  
Carlos Henrique Fernandes ◽  
Cesar Dario Oliveira Miranda ◽  
João Baptista Gomes dos Santos ◽  
Flavio Faloppa
Keyword(s):  
Systematic Review ◽  
Recurrence Rate ◽  
Operative Procedure ◽  
Arthroscopic Surgery ◽  
Surgical Techniques ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Level I ◽  
English Articles ◽  
Midcarpal Joint

The purpose of this systematic review is to determine the incidence of complications and the recurrence rate of a volar wrist ganglion following arthroscopic resection. We performed a systematic review of English and non-English articles using Google Scholar, Medline, and Web of Knowledge. Articles were screened for study inclusion by three independent reviewers using the terms "arthroscopic treatment of volar wrist ganglion" and "arthroscopic resection of volar wrist ganglion". Inclusion criteria: (1) level I–V evidence, (2) documentation of the number of wrists subjected to surgery, (3) documentation of surgical techniques used on wrists, and (4) documentation of surgical or post-surgical complications and recurrence rate of a volar wrist ganglion after arthroscopic resection. A complication was defined as an adverse outcome that was directly related to the operative procedure. Between 2001 and 2012, 13 articles met the inclusion criteria. Two articles were excluded and 11 were reviewed. A total of 232 wrists underwent arthroscopic surgery with 14 recurrences. The recurrence rate ranged from 0 to 20%, with mean of 6.03%. There were 16 (6.89%) complications. There was no connection with the ganglion in six wrists, three haematomas, three cases of neuropraxia of the dorsal radial nerve, two partial lesions of the median nerve, and two lesions of a branch of the radial artery. Patients did not have a decrease in the arc range of motion. Treatment of volar ganglia of the midcarpal joint was technically difficult and associated with a higher number of complications. In general, arthroscopic resection results in fewer complications and lower recurrence rates than an open surgical approach, but there is no clear evidence of such an advantage for arthroscopic resection of a volar wrist ganglion. Additional prospective, controlled clinical trials will be essential to address this important issue.

scholarly journals Surgical Management of Idiopathic Perianal Fistulas: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-16
Author(s):  
Xinyi Cherry Cheung ◽  
Tom Fahey ◽  
Ailin C. Rogers ◽  
John Hogeland Pemberton ◽  
Dara Oliver Kavanagh
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Perianal Fistula ◽  
Surgical Approaches ◽  
Supporting Evidence ◽  
Minimal Risk ◽  
Recurrence Rates ◽  
Perianal Fistulas ◽  
Extensive Evaluation ◽  
Significant Difference

<b><i>Background:</i></b> Perianal fistula is a common colorectal condition with an incidence of 9 per 100,000. Many surgical treatments exist, all aiming to eliminate symptoms with minimal risk of recurrence and impact upon continence. Despite extensive evaluation of the therapeutic modalities, no clear consensus exists as to what is the gold standard approach. This systematic review aimed to examine all available evidence pertaining to the surgical management of perianal fistulas. Primary outcomes examined were recurrence and incontinence. <b><i>Summary:</i></b> This study was conducted according to PRISMA guidelines. Primary outcomes were analyzed for each group and expressed as pooled odds ratio with confidence intervals of 95%. 687 studies were identified from which 28 relevant studies were included. There was no significant difference in rates of incontinence identified between various surgical approaches. Glues and plugs show higher recurrence rates. Newer treatments continue to emerge with promise but lack supporting evidence of benefit over conventional therapies. <b><i>Key Messages:</i></b> While we await more robust randomized data, we will continue to proceed cautiously trying to offset the benefits of fistula healing against the inherent risk of altered continence.

Sildenafil for idiopathic pulmonary fibrosis: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Tyler Pitre ◽  
Muhammad Faran Khalid ◽  
Sonya Cui ◽  
Melanie C. Zhang ◽  
Renata Husnudinov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Meta Analysis ◽  
Rate Of Change ◽  
Point Estimate ◽  
Control Group ◽  
Randomized Controlled Studies ◽  
Significant Difference ◽  
Acute Exacerbations

Abstract Background: Patients with idiopathic pulmonary fibrosis have a poor overall prognosis and there are few evidence based drug therapies that reduce mortality. Objective: This systematic review and meta-analysis aims to assess whether sildenafil reduces mortality, reduces disease progression and the adverse side effects associated with it. Methods: In this review, randomized controlled studies (RCTs) were retrieved from MEDLINE, Cochrane, and EMBASE. The primary outcome was mortality. The secondary outcomes included change in FVC, acute exacerbations and hospitalizations and adverse drug effects leading to discontinuation. We used an inverse variance random effects meta-analysis method to calculate pooled odds ratio (OR) and standardized mean difference (SMD). Results: A total of 4 studies were included. Sildenafil probably reduces mortality when compared to placebo or to standard care, [OR 0.63 (0.38,1.03), I2=0%]. Pooled results showed sildenafil does not alter the rate of change of FVC [SMD 0.02 (-0.14,0.18)], or DLCO [SMR -0.01 (-0.18,0.17)], I2=0]. Pooled results showed sildenafil may not reduce the number of hospitalizations or acute exacerbations, [OR 1.06 (0.67,1.67)], I2= 0]. There was no significant difference in drug discontinuation due to adverse effects when comparing sildenafil to the control group, [OR 0.79 (0.56, 1.11)], I2=0]. Conclusion: Sildenafil probably reduces all-cause mortality in IPF patients. More studies need to be done in order to confirm the magnitude and reliability of the point estimate.

A Systematic Review of Definitive Treatment for Inverted Papilloma Attachment Site and Associations With Recurrence

2021 ◽  
pp. 019459982110519
Author(s):  
Monica S. Trent ◽  
Khodayar Goshtasbi ◽  
Lily Hui ◽  
John A. Gerka Stuyt ◽  
Nithin D. Adappa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Frozen Section ◽  
Surgical Techniques ◽  
Attachment Site ◽  
Inverted Papilloma ◽  
Definitive Treatment ◽  
Recurrence Rates ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Choice Of Technique

Objective Inverted papilloma (IP) is the most common benign neoplasm of the nasal cavity with known risk of recurrence. There is no standardized approach to definitive treatment for attachment sites. This systematic review aims to determine whether surgeon choice of technique differs by anatomic attachment site and whether different surgical techniques contribute to reduced rates of recurrence. Data Sources PubMed and Ovid Medline. Review Methods A systematic review was conducted for studies reporting on IP. Those that included IP recurrence rates and primary tumor attachment site were reviewed. Results Of 122 published studies, 14 met eligibility criteria, representing 585 patients and a recurrence rate of 5.8%. The maxillary sinus (50.9%) was the most common primary attachment site, and the sphenoid sinus was associated with the highest rate of recurrence (10.4%). The most utilized technique included debulking the tumor, removing mucosa over the attachment site, and drilling the underlying bone. The most common Krouse stage represented was T3 (53.3%). No single technique predicted a propensity for recurrence, but certain techniques are favored depending on IP attachment site. Finally, frozen sections to obtain evidence of clear margins intraoperatively significantly reduced rates of recurrence (3.4% vs 7.3%, P = .045). Conclusion Based on the current literature, the most common technique to address site of attachment involves resecting mucosa and drilling the tumor base. Choice of technique appears to differ for various sites of attachment. Use of intraoperative frozen section analysis appears to be associated with decreased recurrence overall. Level of Evidence 3.

Outcomes of vertebroplasty compared with kyphoplasty: a systematic review and meta-analysis

2015 ◽  
Vol 8 (6) ◽  
pp. 636-642 ◽  
Author(s):  
Chris N Gu ◽  
Waleed Brinjikji ◽  
Avery J Evans ◽  
Mohammad H Murad ◽  
David F Kallmes
Keyword(s):  
Systematic Review ◽  
Vertebral Body ◽  
Meta Analysis ◽  
Cement Leakage ◽  
Compression Fractures ◽  
Pain Scores ◽  
Randomized Studies ◽  
Randomized Controlled Studies ◽  
Significant Difference ◽  
Pain Outcomes

Background and purposeMany studies demonstrate that both kyphoplasty and vertebroplasty are superior to conservative therapy in the treatment of osteoporotic vertebral body compression fractures. We performed a systematic review and meta-analysis of studies comparing the outcomes of vertebroplasty and kyphoplasty, which included prospective non-randomized, retrospective comparative, and randomized studies.Materials and methodsWe searched MEDLINE, EMBASE, and the Web of Science databases for studies of kyphoplasty versus vertebroplasty from 1 January 1990 to 30 November 2014 and compared the following outcomes: procedure characteristics, pain and disability improvement, complications and anatomic outcomes. A subgroup analysis was performed comparing pain outcomes based on the risk of bias.Results29 studies enrolling 2838 patients (1384 kyphoplasty and 1454 vertebroplasty) were included. 16 prospective non-randomized studies, 10 retrospective comparative studies, and 3 randomized controlled studies were included. No significant differences were found in mean pain scores between the two groups postoperatively (2.9±1.5 kyphoplasty vs 2.9±1.7 vertebroplasty, p=0.39) and at 12 months (2.7±1.8 kyphoplasty vs 3.2±1.8 vertebroplasty, p=0.64). No significant differences were found in disability postoperatively (34.7±7.1 kyphoplasty group vs 36.3±7.8 vertebroplasty group, p=0.74) or at 12 months (28.3±16 kyphoplasty group vs 29.6±13.9 vertebroplasty group, p=0.70). Kyphoplasty was associated with lower odds of new fractures (p=0.06), less extraosseous cement leakage (p<0.01), and greater reduction in kyphotic angle (p<0.01).ConclusionsNo significant difference was found between vertebroplasty and kyphoplasty in short- and long-term pain and disability outcomes. Further studies are needed to better determine if any particular subgroups of patients would benefit more from vertebroplasty or kyphoplasty in the treatment of vertebral body compression fractures.

scholarly journals What Do We Know About Treating Recalcitrant Auricular Keloids? A Systematic Review and Meta-Analysis

2021 ◽  
pp. 229255032199574
Author(s):  
Luke R. R. Zawadiuk ◽  
Aaron C. Van Slyke ◽  
Jeffrey Bone ◽  
Baillie Redfern ◽  
Nicholas J. Carr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Intervals ◽  
Treatment Modality ◽  
Meta Analysis ◽  
Compression Therapy ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
Recurrence Rates ◽  
Beam Radiation ◽  
Significant Difference

Background: Recalcitrant auricular keloids are keloids that have recurred after any previous treatment. They have been shown to have an increased likelihood of recurrence. There is no consensus on how best to treat recalcitrant auricular keloids. Here, we perform the first systematic review and meta-analysis investigating the evidence for treating recalcitrant auricular keloids. Methods: We searched MEDLINE, EMBASE, CINAHL, and EBM Reviews using specific keywords. Prespecified inclusion and exclusion criteria were used to assess article eligibility. Data were extracted for number of recalcitrant keloids, treatment modality, recurrence, and minimum follow-up time. Included articles were stratified by treatment and assigned a level of evidence (LOE) based on the Oxford Centre for Evidence-Based Medicine guidelines. A meta-analysis was performed to estimate recurrence rates with 95% confidence intervals for each treatment modality. Results: A total of 887 unique articles were identified and 13 included. Eleven were LOE III and 2 were LOE IV. Recurrence rates were found to be 9% (95% CI: 3%-25%) for excision with adjuvant brachytherapy, 14% (95% CI: 12%-17%) for excision with adjuvant compression therapy, 17% (95% CI: 3%-56%) for excision with adjuvant external beam radiation, and 18% (95% CI: 4%-53%) for excision with adjuvant steroid injections. No statistical significant difference was found. Conclusions: Data for treatment of auricular keloids are heterogeneous with few high-quality studies. Excision with adjuvant brachytherapy has the lowest recurrence rate in our analysis. Narrow confidence intervals reported here for brachytherapy and compression therapy may help surgeons more confidently recommend either of these treatment modalities to patients.

scholarly journals The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols

2021 ◽  
Vol 18 (16) ◽  
pp. 8432
Author(s):  
Olga Di Fede ◽  
Federica Canepa ◽  
Vera Panzarella ◽  
Rodolfo Mauceri ◽  
Carmine Del Gaizo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Techniques ◽  
Conservative Surgery ◽  
Pooled Analysis ◽  
Osteonecrosis Of The Jaw ◽  
Blood Component ◽  
Antiangiogenic Agents ◽  
Improvement Rate ◽  
Non Invasive ◽  
Significant Difference

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements

scholarly journals Unicompartmental Knee Replacement in Obese Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3594
Author(s):  
Stefano Campi ◽  
Giuseppe Francesco Papalia ◽  
Carlo Esposito ◽  
Erika Albo ◽  
Francesca Cannata ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Oxford Knee Score ◽  
Surgical Techniques ◽  
Unicompartmental Knee Replacement ◽  
Obese Patients ◽  
Unicompartmental Knee ◽  
Significant Difference ◽  
The Impact

Thanks to modern surgical techniques and implants, traditional exclusion criteria for unicompartmental knee arthroplasty (UKA) are no longer considered contraindications. The aim of this study is to clarify the impact of obesity on functional outcomes and revision rates of UKA. We performed a comprehensive systematic review using PubMed–Medline, Google Scholar and Cochrane Central. Then, we extracted data related to body mass index (BMI), age and follow-up, functional outcome scores and rate of revisions (all-cause, aseptic and septic). Patients were stratified according to BMI into two groups: non-obese (BMI < 30) and obese (BMI ≥ 30). We identified 22 eligible studies, of which 13 were included in the meta-analysis. Patients with a BMI > 30 had a significantly higher likelihood for revision (p = 0.02), while the risk of septic revision was similar (p = 0.79). The clinical outcome measures showed a significant difference in favor of patients with a BMI < 30 (p < 0.0001). The improvements in Oxford Knee Score and Knee Society Score were significant in both obese and non-obese patients, although the latter showed inferior results. The results of this systematic review and meta-analysis show that BMI is not a contraindication to UKA. However, obese patients have a higher risk for aseptic failure and lower improvement in clinical scores compared to non-obese patients.

Pelvic Lymphadenectomy and Pelvic and Para-Aortic Lymphadenectomy Versus No Lymphadenectomy for Endometrial Cancer

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 29-29
Author(s):  
Loay M. Gertallah ◽  
Abdelwahab S. Almoregy ◽  
Taha A. Baiomy ◽  
Khaled Fathy Helal ◽  
Mohamed Fathy Abohashim ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Cohort Analysis ◽  
Prognostic Significance ◽  
Surgical Techniques ◽  
Disease Free Survival ◽  
Pelvic Lymphadenectomy ◽  
Recurrence Rates ◽  
Free Survival ◽  
Treatment Groups ◽  
Significant Difference

Background: Although lymphadenectomy is advised for accurate surgical endometrial-carcinoma staging, the procedure is not performed regularly worldwide. Most studies on it include few patients and mainly compare pelvic with pelvic/para-aortic lymphadenectomy. Comparing lymphadenectomy with non-lymphadenectomy is rare. The current study examined prognostic significance and survival advantages of pelvic and pelvic/para-aortic lymphadenectomy compared to no lymphadenectomy. Materials and Methods: This was a retrospective cohort analysis of 75 patients with endometrial carcinomas. The patients were divided into 3 treatment groups based on whether or not lymph-node dissection was performed and the extent of the dissections: (1) pelvic lymphadenectomy; (2) pelvic/para-aortic lymphadenectomy; and (3) no lymphadenectomy. Correlations were analyzed among the surgical techniques used for the 3 groups with respect to the need for adjuvant radiotherapy or chemotherapy, recurrences, and survival outcomes. Results: Pelvic and pelvic/para-aortic lymphadenectomy produced more-favorable overall survival (OS) and progression-free survival (PFS) rates than no lymphadenectomy (p = 0.047). A significant difference was noted among the 3 treatment groups for OS rate and disease-free survival rates (p = 0.015 and 0.017, respectively). The recurrence rates were 47.1%, 35.7%, and 68.8% in the pelvic lymphadenectomy, and pelvic/para-aortic lymphadenectomy, and no lymphadenectomy groups, respectively (p = 0.037). Conclusions: This study showed that pelvic and para-aortic lymphadenectomy improved the OS and PFS rates of patients with endometrial cancer.

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