scholarly journals Systematic surgical exploration or observation and selective exploration of suspected traumatic mesenteric and bowel injuries: A meta-analysis

2021 ◽  
Keyword(s):  
High Risk ◽  
Blunt Trauma ◽  
Complication Rate ◽  
Clinical Observation ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Low Risk ◽  
Quality Data ◽  
Trauma Patients ◽  
Surgical Exploration

Context: Mesenteric and bowel injuries (MBI) are rare and dangerous presentations of blunt abdominal trauma and often cause clinical uncertainty since their diagnosis is difficult and operative treatments are often delayed. No clear guidelines exist regarding this topic, and due to the rarity of the injury, few and highly low-quality data are available. This study aimed to compare early surgical exploration, delayed surgical exploration, and non-operative management in patients with proven and suspected blunt MBI. Evidence Acquisition: Detailed research was performed on Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until 29th November 2019. The studies that were considered eligible to be included in this systematic review and consequent meta-analysis were those focusing on patients with proven MBI or computed tomography (CT) signs suspected for them and comparing early surgical exploration (EOR) with delayed one (DOR) or with selective surgical exploration (SOR) after clinical observation. The eligible studies were sub-grouped into those using a delay cut-off (to distinguish “early” and “deferred” surgical intervention) higher than 12 h and those using a cut-off lower than 12 h, as well as those focusing on patients with high-risk CT signs (pneumoperitoneum and active mesenteric bleeding) and those focusing on patients with low-risk ones. Results: Finally, 16 studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 2,702 patients. All studies, although not randomized, were considered to be at the acceptable risk of bias in the important domains. It was found that in patients with proven MBI, in the subgroup of studies with a delay cut-off for surgical intervention lower than 12 h, the complication rate was significantly lower in EOR, compared to DOR (risk ratio [RR]=0.47, 95% CI=0.29-0.79, P=0.004). In patients with suspected MBI with low-risk CT signs, the complication rate was significantly lower in SOR, compared to EOR (RR=1.79, 95% CI=1.27-2.53, P=0.001). It was also revealed that in patients with high-risk CT signs, the complication rate and the length of stay (LOS) were significantly lower in EOR, compared to DOR (complication: RR=0.38, 95% CI=0.17-0.84, P=0.02; LOS: mean difference=-12.00, 95% CI=-21.44-2.56, P=0.01). Conclusions: The present meta-analysis confirmed that in patients with proven blunt MBI a delay of surgical intervention higher than 12 h would lead to a higher complication rate and a longer LOS. Based on the results, in blunt trauma patients with pneumoperitoneum or active mesenteric bleeding at the admission CT scan, complications and LOS could be reduced by performing an early surgical exploration. On the other hand, in blunt trauma patients with low-risk CT signs of suspected MBI, a clinical observation with selective surgical exploration in case of clinical or radiological worsening could reduce the complication rate without increasing mortality and LOS.

Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

scholarly journals Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuanyuan Chen ◽  
Dongru Chen ◽  
Huancai Lin
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Meta Analysis ◽  
Low Risk ◽  
Caries Risk ◽  
Moderate Risk ◽  
Risk Levels ◽  
Non Invasive ◽  
Randomised Controlled ◽  
Caries Lesions

Abstract Background Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels. Methods Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. Results In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15–0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18–0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20–0.45; permanent dentition: OR = 0.20, 95% CI 0.14–0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.17, 95% CI 0.10–0.29; and high risk: OR = 0.14, 95% CI 0.07–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.20, 95% CI 0.10–0.39; and high risk: OR = 0.14, 95% CI 0.05–0.37). Conclusion Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.

scholarly journals Corrigendum to “Routine pelvic X-rays in asymptomatic hemodynamically stable blunt trauma patients: A meta-analysis” [Injury 49 (11) (2018) 2024–2031]

Injury ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 621
Author(s):  
Jessica van Trigt ◽  
Niels Schep ◽  
Rolf Peters ◽  
Carel Goslings ◽  
Tim Schepers ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Meta Analysis ◽  
Trauma Patients ◽  
X Rays

scholarly journals Does Mode of Surgical Intervention Based on Oncotype DX Score Influence Disease Recurrence in Early Breast Cancer?

2020 ◽  
Vol 06 (02) ◽  
pp. e135-e138
Author(s):  
T. M. Aherne ◽  
M. R. Boland ◽  
D. Catargiu ◽  
K. Bashar ◽  
T. P. McVeigh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Early Breast Cancer ◽  
Local Excision ◽  
Wide Local Excision ◽  
Surgical Intervention ◽  
Disease Recurrence ◽  
Low Risk ◽  
Oncotype Dx ◽  
Significant Difference

Abstract Introduction Routine utilization of multigene assays to inform operative decision-making in early breast cancer (EBC) treatment is yet to be established. In this pilot study, we sought to establish the potential benefits of surgical intervention in EBC based on recurrence risk quantification using the Oncotype DX (ODX) assay. Materials and Methods Consecutive ODX tests performed over a 9-year period from October 2007 to May 2016 were evaluated. Oncotype scores were classified into high (≥31), medium (18–30), or low-risk (0–17) groups. The primary outcome was breast cancer recurrence. Subgroup analysis offered assessment of the recurrence effect of mode of surgical intervention for patient groups as defined by the oncotype score. Results In total 361 patients underwent ODX testing. The mean age and follow-up were 55.25 (± 10.58) years and 38.59 (± 29.1) months, respectively. The majority of patients underwent wide local excision (86.7%) with 8.9 and 4.4% patients having a mastectomy or wide local excision with completion mastectomy, respectively. Fifty-one percent of patients fell into the low risk ODX category with a further 40.2 and 8.5% deemed to be of intermediate and high risk. Five patients (1.38%) had disease recurrence. Comparative analysis of operative groups in each oncotype group revealed no difference in recurrence scores in the low- (p = 0.84) and high-risk groups (p = 0.92) with a statistically significant difference identified in the intermediate risk group (p = 0.002). Conclusion To date we have been unable to definitively identify a role for ODX in guiding surgical approach in EBC. There is, however, a need for larger studies to examine this hypothesis.

Abstract 354: The Effect Of Early Surgery on Outcomes in Infective Endocarditis- A Meta- Analysis of 25,732 Patients

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Waleed T Kayani ◽  
Najia Idrees ◽  
Salman Bandeali ◽  
Don Pham ◽  
Anam Khan ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Quality Data ◽  
Early Surgery ◽  
All Cause Mortality ◽  
The Subject ◽  
Surgery Mortality ◽  
The Impact

Despite a rising incidence of infective endocarditis (IE), its associated mortality remains high. It is estimated that at least 30% of patients with IE undergo surgery, however data on outcomes of outcomes associated with timing of surgical intervention in this setting is limited. Existing literature mainly consists of observational studies with conflicting results, and current guidelines (ACC/ AHA and Society of Thoracic Surgeons) base recommendations largely on small retrospective studies and expert opinion. We sought to determine the effect of early surgery on outcomes after IE by performing the first comprehensive meta- analysis on the subject. A comprehensive literature search using PubMed (MEDLINE) was performed using keywords “endocarditis”, “surgery”, “mortality” and “outcome”. Early surgery was defined as surgical intervention performed during index hospitalization. Primary outcome of interest was all-cause mortality. Secondary outcomes included incidence of recurrent endocarditis and embolic phenomenon. Of 117 identified studies, 36 met the inclusion criteria (25,732 patients). Data on baseline characteristics and outcomes of interest were extracted. Meta-analysis was performed using Review Manager Version 5.0 (Cochrane Collaboration). Effect sizes for outcomes of interest were estimated using odds ratio (OR) and 95% confidence intervals (CI). Given the inherent heterogeneity among included studies, results from the random effects model are reported. Of the included 25,732 patients, 7,835 underwent early surgery compared to 17,537 who received conventional treatment. A significant reduction in both, short and long term mortality in patients who underwent early surgery OR 0.58 (95% CI 0.47-0.70; p = <0.001) and OR 0.49 (95% CI 0.37-0.65; p = 0.001) respectively was seen. The incidence of recurrent endocarditis or embolic phenomenon did not differ between the two groups. This is the first comprehensive meta-analysis to examine the impact of early surgery on outcomes in patients with IE. Our results indicate that early surgery is associated with a significant reduction in all-cause mortality in patients with IE, without an increase in incidence of recurrent endocarditis. These findings are of clinical significance given paucity of quality data on the subject.

scholarly journals Yield of serious axial injury from pan scans after blunt trauma in haemodynamically stable low‐risk trauma patients

2018 ◽  
Vol 31 (3) ◽  
pp. 399-404 ◽  
Author(s):  
Jessica Roberts ◽  
Sara Watts ◽  
Sharon Klim ◽  
Peter Ritchie ◽  
Anne‐Maree Kelly
Keyword(s):  
Blunt Trauma ◽  
Low Risk ◽  
Trauma Patients

The Validity and Utility of Risk Assessment for Inpatient Suicide

2011 ◽  
Vol 19 (6) ◽  
pp. 507-512 ◽  
Author(s):  
Matthew Large ◽  
Christopher Ryan ◽  
Olav Nielssen
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Model ◽  
Psychiatric Patients ◽  
Meta Analysis ◽  
Low Risk ◽  
Prior History ◽  
Inpatient Suicide ◽  
History Of ◽  
Self Harm

Objective: It is widely assumed that identifying clinical risk factors can allow us to determine which patients are at high risk of suicide while in hospital, and that identifying those patients can help prevent inpatient suicide. We aimed to examine the validity and utility of categorizing psychiatric patients to be at either high or low risk of committing suicide while in hospital. Method: The assumption that high-risk categorizations are valid was examined by comparing factors included in high-risk models derived from individual studies of inpatient suicide with the results of a meta-analysis of factors associated with inpatient suicide. A valid high-risk model was then applied to a hypothetical clinical setting in order to test the assumption that high-risk categorizations are useful. Results: The existing models for assessing whether inpatients are at high risk of suicide all include one or more factors that were not found to be associated with inpatient suicide by meta-analysis and were probably chance associations. Depressed mood and a prior history of self-harm are the only well-established independent risk factors for inpatient suicide. Using these risk factors to classify patients as being at high or low risk would prevent few, if any, suicides, and would come at a considerable cost in terms of more restrictive care of many patients and the reduced level of care available to the remaining patients. Conclusions: Risk categorization of individual patients has no role to play in preventing the suicide of psychiatric inpatients.

scholarly journals Could aspirin be a lifesaver for prostate cancer patients in prostate cancer-specific mortality?: an update systematic review and meta-analysis

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jiatong Zhou ◽  
Shuai Xia ◽  
Tao Li ◽  
Ranlu Liu
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Literature Search ◽  
Meta Analysis ◽  
Low Risk ◽  
Prognostic Effect ◽  
Diagnostic Use ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Comprehensive Literature Search

Abstract Background Currently, clinical studies on the prognosis of prostate cancer (PC) taking aspirin were developing, but the precise mechanism of aspirin on tumor cells was still unclear. In addition, the conclusion that aspirin can improve the prognosis of PC patients continues to be controversial. Therefore, we collected comprehensive literatures and performed our study to explore the prognostic effect of aspirin on PC. Methods A comprehensive literature search was performed in April 2019 based on PUBMED. EMBASE. Hazard Ratio (HR) as well as its 95% confidence interval (CIs) for prostate cancer specific mortality (PCSM) was extracted from eligible studies. Result A total of 10 eligible articles were used in our study. The pooled results showed that PC patients who used aspirin or taking aspirin did not have lower PCSM than those who had not used (HR =0.89, 95% CI: 0.73–1.08, P>0.05). In subgroup analysis, we found that taking aspirin before diagnosis of prostate cancer and taking aspirin after diagnosis of prostate cancer did not have significant association with PCSM. (pre-diagnostic use, HR = 0.88, 95% CI: 0.72–1.06; post-diagnosis use, HR = 0.88, 95% CI: 0.67–1.17). In addition, we found no significant association between aspirin use or its duration and the risk of PCSM. Another important result demonstrated that aspirin use was not associated with risk of PSCM in either high risk (T ≥ 3 and/or Gleason score ≥ 8) or low risk PC patients(low-risk PC, HR = 1.05, 95% CI: 0.81–1.35; high-risk PC, HR = 0.97, 95% CI: 0.75–1.24). Conclusion Our results demonstrated that there was no significant association between aspirin use and the risk of PCSM. At the same time, the dosage and duration of aspirin use had no statistical influence on the risk of PCSM in high/low risk PC. Further studies are needed to confirm the findings.

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