Current Trends In Treatment Research Articles

Current status of cardiovascular surgery in Japan, 2015 and 2016: analysis of data from Japan Cardiovascular Surgery Database. 4-Thoracic aortic surgery.

Thoracic and thoracoabdominal aortic diseases are treated using operative procedures like open aortic repair (OAR), thoracic endovascular aortic repair (TEVAR), or hybrid aortic repair (HAR), or a combination of OAR and TEVAR. The surgical approach to aortic repair has evolved over the decades. The purpose of this study was to examine the current trends in treatment. We extracted nationwide data of aortic repair procedures performed in 2015 and 2016 from the Japan Cardiovascular Surgery Database (JCVSD). In addition to estimating the number of cases, we also reviewed the respective operative mortalities and associated major morbidities (e.g., stroke, spinal cord insufficiency, and renal failure) according to disease pathology (e.g., acute dissection, chronic dissection, ruptured aneurysm, and unruptured aneurysm), site of operative repair (i.e., aortic root, ascending aorta, aortic root to arch, aortic arch, descending aorta, and thoracoabdominal aorta), and the preferred surgical approach (i.e., OAR, HAR, or TEVAR). The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. Compared to the data from our previous report (also derived from the JCVSD in 2013 and 2014), the total number of cases and number of OAR, HAR, and TEVAR procedures have increased by 17.0%, 2.4%, 126.1%, and 34.9%, respectively. While the overall stroke rates following aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3%, respectively, OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9%, and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. The number of operations for thoracic and thoracoabdominal aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting aortic arch aneurysms.

Современные тенденции в лечении глазных проявлений гипоплазминогенемии у детей

Современные тенденции в лечении глазных проявлений гипоплазминогенемии у детей

Aktuální trendy v léčbě kožních alergií

Aktuální trendy v léčbě kožních alergií

Correction to: Current trends in operative treatment of carpometacarpal osteoarthritis: a survey of European hand surgeons

The entries in Tables 1, 2 and 3 were captured as N = 433,439 instead of N = 439. The correct tables are shown below. (Table Presented.).

Evaluation of Current Trends in Treatment of Single-level Cervical Radiculopathy.

This was a retrospective cohort study. The main objectives of this study were to identify epidemiological trends, differences, and complications in patients undergoing surgical treatment for single-level cervical radiculopathy (SLCR). SLCR that fails nonoperative management is effectively treated with either anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), or posterior cervical foraminotomy (PCF). Although studies have shown that all 3 options are clinically effective, trends in usage, differences in patient population, and differences in complications remain unknown. Patients who underwent either ACDF, CDR, or PCF in the treatment of SLCR from 2010 to 2016 were retrospectively reviewed using the National Surgical Quality Improvement Program (NSQIP) database. Demographic data consisted of sex, age, ASA class, body mass index, and inpatient/outpatient status. Complications included surgical site infection, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, readmissions, reoperations, operating time, and hospital length of stay. Utilization trends by year among the 3 procedures were also analyzed. A total of 1102 patients with SLCR treated with single-level ACDF, CDR, or PCF were identified in NSQIP from 2010 to 2016. There was a relative increase in the number of CDR procedures (7.7%-16.1%) and a corresponding decrease in PCF procedures (20.3%-10.6%) without a significant effect on ACDF procedures (72.0%-73.3%). Patients who underwent CDR were younger and in a lower ASA class than those undergoing ACDF or PCF. Patients undergoing PCF were more likely to be treated as an outpatient. PCF procedures also had the shortest operating time and hospital length of stay. There were no significant differences in complications among the 3 procedures. Moreover, there were no significant trends in demographics or outcome measures. ACDF remains the most common surgical treatment for patients with SLCR, and its utilization has remained consistent. Meanwhile, the increased utilization of CDR for the treatment of SLCR has resulted in a corresponding decrease in the utilization of PCF.

Modern possibilities of organ-preserving treatment of patients with muscle-invasive bladder cancer

The article reviews the current trends in the organ-preserving treatment of patients with muscular-invasive bladder cancer. An historical insight into the treatment tactics for this malignant disease included. The current trends in the use of surgical technology, radiation therapy, chemotherapy and immunotherapy, as well as molecular genetic diagnostic in patients with invasive bladder carcinomas are demonstrated. Due to the lack of randomized studies we are not able to use such organ-preserving techniques into practice, but it allows to performthis approach in carefully selected groups of patients.

Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs.

The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.

Современные тенденции в лечении воспалительных заболеваний глазной поверхности у детей

Современные тенденции в лечении воспалительных заболеваний глазной поверхности у детей

Perioperative chemotherapy is not associated with improved survival in stage I pleomorphic lung cancer

ObjectivesPulmonary pleomorphic carcinoma represents an understudied, rare, and aggressive histologic subtype of non–small cell lung cancer. Better understanding of rare disease subtypes allows for improved individualization of patient care. This study aimed to evaluate current trends in treatment and survival of pleomorphic carcinoma. MethodsThe National Cancer Database was used to identify patients with staged, pleomorphic carcinoma and adenocarcinoma between 2004 and 2015. Patient characteristics and treatments were compared using χ2 tests. Cox proportional hazard models examined survival by stage after controlling for confounders. Propensity score matched Kaplan-Meier curves estimated survivor functions stratified by stage. Differences in survival following treatment for stage I pleomorphic carcinoma with surgery alone versus surgery plus chemotherapy were compared with Cox proportional hazard models and Kaplan-Meier survival curves. ResultsOne thousand four hundred eight patients with pleomorphic carcinoma and 607,561 patients with adenocarcinoma were identified. Pleomorphic carcinoma accounted for 0.1% of all non–small cell lung cancers. Pleomorphic disease had poorer overall 5-year survival compared with adenocarcinoma for stages I through IV (49.4% vs 59.1%, 34.5% vs 43.8%, 16.9% vs 28.4%, and 5.7% vs 7.8%, respectively; P < .0047 for all). Perioperative chemotherapy was used more frequently for pleomorphic disease (17.5% vs 6.1%; P < .001). For stage I pleomorphic cancer, treatment with surgery alone (n = 253) and surgery with chemotherapy (n = 57) had overall 5-year survival rates of 55.2% and 53.7%, respectively, and were not significantly different (P = .2868). ConclusionsPulmonary pleomorphic carcinoma is rare and aggressive, with worse survival when compared with adenocarcinoma. Perioperative chemotherapy has not demonstrated significant survival benefits in stage I pleomorphic cancer.

Chronic osteomyelitis: a review on current concepts and trends in treatment

Osteomyelitis is a complex and potentially devastating condition. Appropriate therapy requires a multimodal orthoplastic approach and the cornerstone of treatment is surgical management. The aim is eradication of infection by thorough debridement, leaving only viable tissue and restoring function. Despite the unquestionable need for surgical debridement in chronic osteomyelitis, the need for reliable radiological and tissue diagnosis along with appropriate antimicrobial therapy is paramount for the success of treatment. The route of administration and duration of antimicrobial therapy continues to be debated. The role of biofilm is now clearly established in the chronicity of bone infection, and newer modalities are being developed to address various issues related to biofilm formation. We aim to review the current trends and concepts for treatment of chronic osteomyelitis in this article. This includes the traditional and more novel techniques for obliterating osseous and soft tissue dead space as well as restoring bony stability and function.

Current trends in operative treatment of carpometacarpal osteoarthritis: a survey of European hand surgeons

BackgroundSurgical practice patterns in operative treatment of carpometacarpal (CMC-1) osteoarthritis (OA) have been evaluated in the USA repeatedly. This study evaluates the current surgical patterns in the treatment of isolated CMC-1 OA among hand surgeons in Europe.MethodsAn online survey was distributed to hand surgeons of participating member states of the Federation of European Societies for Surgery of the Hand (FESSH). Information regarding country of practice, years of experience and surgical treatment of choice was collected. Statistical analyses of correlations between demographics and treatment preferences were done using chi-squared testing.ResultsA total of 444 replies were recorded. Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) was opted by 46% of the respondents as a procedure of first choice, followed by prosthetic joint replacement (25%) and trapeziectomy with interpositional arthroplasty (23%). Among surgeons practicing in the Netherlands, 35% mentioned trapeziectomy without any complementary procedures as a surgical treatment of first choice. Prosthetic joint replacement is chosen by respectively 96% and 72% of the respondents in Belgium and France as a preferred surgical procedure.ConclusionsThis European-wide study provides insight in the prevailing surgical management for isolated CMC-1 OA. Trapeziectomy with LRTI is the most popular procedure among the participating hand surgeons in Europe. Geographical trends seem to play an important role in the choice of preferred technique. Factors influencing the decision-making among surgeons practicing in different countries should be explored more closely in future studies.Level of evidenceLevel IV, prognostic study.

The Meniscus in Normal and Osteoarthritic Tissues: Facing the Structure Property Challenges and Current Treatment Trends.

The treatment of meniscus injuries has recently been facing a paradigm shift toward the field of tissue engineering, with the aim of regenerating damaged and diseased menisci as opposed to current treatment techniques. This review focuses on the structure and mechanics associated with the meniscus. The meniscus is defined in terms of its biological structure and composition. Biomechanics of the meniscus are discussed in detail, as an understanding of the mechanics is fundamental for the development of new meniscal treatment strategies. Key meniscal characteristics such as biological function, damage (tears), and disease are critically analyzed. The latest technologies behind meniscal repair and regeneration are assessed.

Current Treatment Trends in Rotator Cuff Disease

Rotator cuff disease is one of the most common causes of shoulder pain in the orthopaedic setting. Symptoms can vary widely from pain due to simple inflammation to pseudoparalysis from massive, irreparable tears. Diagnostic imaging and surgical treatment vary widely depending on the severity of the pathology. This article will explore the current literature of trending orthopaedic imaging and surgical options depending on the presenting course of rotator cuff pathology.

Initial management of meningiomas: Analysis of the National Cancer Database

BackgroundMeningiomas are the most common central nervous system tumor. We describe current trends in treatment and survival using the largest cancer dataset in the United States. MethodsWe analyzed the National Cancer Database from 2004 to 2014, for all patients with diagnosis of meningioma. Results201,765 cases were analyzed. Patients were most commonly White (81.9%) females (73.2%) with a median age of 64 years. Fifty percent of patients were diagnosed by imaging. Patients were reported as grade I (24.9%), grade II (5.0%), grade III (0.7%), or unknown WHO grade (69.4%). Patients diagnosed by imaging were older, received treatment in community facilities, had higher Charlson-Deyo score, and a lower rate of private insurance. Watchful waiting was the most common treatment modality (46.7%), followed by surgery only (40%). Grade II and III patients were more likely to receive therapy. Watchful waiting increased from 35.2% in 2004 to 51.4% in 2014. Younger age, male gender, private insurance, and treatment in academic facilities were determinants for receipt of surgery and/or radiation. Median survival was 12.6 years, higher in histologically confirmed cases (13.1 years). Older patients, Blacks, males, those that received radiation plus surgery, and were treated in community facilities had an increased risk of mortality. ConclusionsOver half of patients were diagnosed by imaging, suggesting a higher role of clinical determinants over histological confirmation in treatment decisions. Watchful waiting as initial management is increasing. Our survival analysis favored histological confirmation. Patients receiving radiation and surgery had an increased risk of mortality.

Nationwide survey of outcome in patients with extensive aganglionosis in Japan.

Hirschsprung's disease-related short bowel syndrome (HDSBS) is characterized by aganglionosis that extends orally to 75cm from Treitz's band. The condition is reported be associated with a high mortality rate of 50-80%. This retrospective study aimed to survey the current trends in HDSBS treatment in Japan. Patient data were extracted from the results of a nationwide survey we conducted, resulting in the retrospective collection of the data of 1087 HD patients from 2008 to 2012 in Japan. A total of 11 (0.9%) cases of HDSBS were noted. All patients underwent jejunostomy as neonates. Radical procedures performed in five patients (A-colon patch method in four, Duhamel's procedure in one). Ziegler's myotomy-myectomy and serial transverse enteroplasty (STEP) were performed in each patient as palliative procedures. No radical operations were performed in 4 of the 11 cases. The mortality rate was 36.4%. Four patients died, 1 patient who underwent STEP and 3 patients who received no radical procedures. The causes of death were sepsis due to enterocolitis or central intravenous catheter infection, and hepatic failure. All patients who underwent radical procedures survived and showed satisfactory outcomes. HDSBS still showed a high mortality rate, although surgical approaches such as the A-colon patch method resulted in satisfactory outcomes.

Current Trends in the Surgical Treatment of Open-Book Pelvic Ring Injuries: An International Survey Among Experienced Trauma Surgeons.

In the open-book, rotationally unstable (OTA/AO type 61-B1.1) pelvic ring injury, the posterior sacroiliac complex is believed to remain intact. Therefore, anterior ring stabilization alone has been the standard treatment recommendation. However, treatment failures using this method have caused a reconsideration of this management strategy. Anterior plus posterior fixation is the main alternative. In the absence of any specific new guidelines, the choice of treatment currently relies on the preference of the treating surgeon. The objective of this survey was to determine the relative use of anterior plus posterior fixation, as opposed to the standard anterior fixation alone, for the treatment of open-book pelvic ring injuries. An international group of 176 practicing trauma surgeons experienced in pelvic ring fracture fixation participated in an AO Foundation survey asking for their preferred standard surgical fixation (anterior alone or anterior plus posterior combined) for OTA/AO type 61-B1.1 open-book pelvic fractures. Anterior plate fixation alone (group 1) was preferred by 56% of the survey participants, and combined anterior plus posterior fixation (group 2) was preferred by 44%. Statistical analysis revealed that group 1 participants were significantly older than group 2 participants (P = 0.03) and had more years of surgical experience (P = 0.02). Concern regarding the inadequacy of anterior fixation alone has led many surgeons, especially those more recently in practice, to add posterior fixation, despite limited data to determine its indications. No doubt the OTA/AO type B 1.1 pelvic ring disruption actually represents a wide spectrum of injury. Further study is needed to determine the best fixation method.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CRS) for Colorectal Cancer: Potential for Individualized Care, Review of Current Treatment Trends, Recent Advancements, and a Look into the Future

Peritoneal metastases (PM) secondary to colorectal cancer is associated with a poor prognosis. However, cytoreductive surgery with hyperthermia intraperitoneal chemotherapy (CRS/HIPEC) has risen to a more accepted roll in the treatment of peritoneal metastatic disease for various cancers; colorectal cancer is no exception. This review aims to discuss the recent updates and findings for treatment of peritoneal disease secondary to colorectal cancer, especially with respect to individualized patient factors that affect outcomes. There are many new studies showing the validity of cytoreductive surgery CRS/HIPEC in a select group of patients with PM. Many studies show that lower peritoneal cancer index score, use of various chemotherapeutic regimens, histology, preoperative health status, adequate nutrition, and other factors all benefit survival/treatment of this unique patient group. Current evidence supports an aggressive multidisciplinary approach to peritoneal disease secondary to colorectal cancer. Standardized treatment practice, highly selective patient criteria, low PCI score, and early recognition of patients at risk for PM show survival benefits and better outcomes for patients with a disease process that was once only treated with palliative interventions.

Gestational diabetes: Current trends in treatment and long-term complications

Gestational diabetes: Current trends in treatment and long-term complications

Deep Venous Thrombosis

In a patient with DVT, a clot forms in the large veins of the extremities, typically the leg, which can lead to a pulmonary embolus, a potentially life-threatening medical problem. Risk factors include provoking factors such as recent surgery, acquired factors such as obesity or cardiovascular disease, and genetic factors such as protein C or S deficiency. The Wells DVT score is a clinical scoring system that allows the assessment of the pretest probability of DVT. However, clinical gestalt has been found to be equally accurate. This can then guide the clinical work-up of the patient, with low and moderate pretest probabilities, allowing one to start with D-dimer testing, versus high probability, requiring one to begin with lower extremity US. The current trend in treatment of DVT is the novel oral anticoagulants as they can be given at fixed doses, do not require laboratory monitoring, and have a better safety profile than warfarin. Pregnant patients, those with cancer, as well as many with recurrent DVT are treated with low-molecular-weight heparin. Most patients with DVT may be treated as an outpatient. A small percentage of patients with severe DVT may benefit from catheter-directed thrombolysis. This review contains 1 figures, 2 tables, and 48 references. Key Words: anticoagulants, D-dimer, diagnostic ultrasonography, DVT, low molecular weight heparin, postthrombotic syndrome, unfractionated heparin, warfarin

Deep Venous Thrombosis

In a patient with DVT, a clot forms in the large veins of the extremities, typically the leg, which can lead to a pulmonary embolus, a potentially life-threatening medical problem. Risk factors include provoking factors such as recent surgery, acquired factors such as obesity or cardiovascular disease, and genetic factors such as protein C or S deficiency. The Wells DVT score is a clinical scoring system that allows the assessment of the pretest probability of DVT. However, clinical gestalt has been found to be equally accurate. This can then guide the clinical work-up of the patient, with low and moderate pretest probabilities, allowing one to start with D-dimer testing, versus high probability, requiring one to begin with lower extremity US. The current trend in treatment of DVT is the novel oral anticoagulants as they can be given at fixed doses, do not require laboratory monitoring, and have a better safety profile than warfarin. Pregnant patients, those with cancer, as well as many with recurrent DVT are treated with low-molecular-weight heparin. Most patients with DVT may be treated as an outpatient. A small percentage of patients with severe DVT may benefit from catheter-directed thrombolysis. This review contains 1 figures, 2 tables, and 48 references. Key Words: anticoagulants, D-dimer, diagnostic ultrasonography, DVT, low molecular weight heparin, postthrombotic syndrome, unfractionated heparin, warfarin