Effect Of Surgery Research Articles

Ancillary treatment referrals and visits after breast cancer surgery in a sociodemographically diverse population.

1533 Background: Ancillary therapies by rehabilitative, palliative, and survivorship specialists mitigate breast cancer surgery's physical and emotional effects. Existing data suggest that patients from disadvantaged backgrounds may be less likely to receive such care. We investigated provider referrals and patient visits at a high-volume urban cancer center to identify associated sociodemographic factors and characterize which populations may not be maximally benefiting from ancillary services. Methods: Data was culled from electronic health records of surgically-treated breast cancer patients at Yale-New Haven Health System between 2010-2017. Post-operative provider referrals to Physical/Occupational Therapy, Palliative Medicine, and Survivorship Program were evaluated for associations with demographic and disease variables in univariable and multivariable logistic regression analyses. Patient utilization of referrals, defined as attending at least one consultation, were analysed similarly. Results: Among 5,496 patients identified, 2,288 (41.6%) were referred for ancillary treatments and 1,572 (28.6%) attended at least one consultation. Provider referrals were highest among patients of Hispanic and Black ancestry (57.5% and 54.9%, respectively), no health insurance (57.6%), lowest percentage high school degree for zip code (50.5%), and lowest median income for zip code (50.7%). These associations remained significant in multivariable analysis [all p<0.050]. In contrast, referral utilization was greatest among patients with private insurance (70.7%), highest percentage high school degree (72.8%), and highest median household income (72.2%), in addition to Hispanic ethnicity (73.5%). In multivariable analysis, highest median household income (OR 1.45, p = 0.019) and Hispanic ethnicity (OR 1.50, p = 0.048) remained associated. Conclusions: In a large urban health system serving a diverse population, traditional markers of poor healthcare access were positively associated with provider referral for ancillary services after breast cancer surgery. However, referral did not translate to utilization, suggesting that access remains a critical barrier to therapies that target post-operative morbidity and elevate quality of life.[Table: see text]

Normalizing intersex children through genital surgery: the medical perspective and the experience reported by intersex adults

This paper explores the conceptions of specialized physicians regarding intersex child surgery, and contrasts them with the experiences of intersex adults. The gap between the views of health personnel—who affirm that they are “doing their best”—and those of intersex persons—who report the adverse consequences of surgery—highlights the need to stop unnecessary normalization surgeries in children. The findings of this study suggest that bridging the gap between the medical perspective and the experience of intersex people requires opening direct channels of communication among all those involved in the clinical process, incorporating intersex individuals into bioethics committees, encouraging contact with the parents of intersex children, implementing regulations that unambiguously delay or prohibit unnecessary interventions, promoting a debate on relevant ethical principles and human rights to protect the interests of all intersex people, and disseminating the contents of such a debate.

Outcomes of octogenarians undergoing holmium laser enucleation of prostate.

Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP. We performed a retrospective review of HoLEPs at our institution from July 2018 to December 2019. Patients were stratified into two groups based on age: < 80 and ≥ 80. A total of 458 patients were identified, with 74 (16.2%) ≥ 80. In patients ≥ 80, prostate volume was higher (p < 0.0005), there was a higher rate of antiplatelet/anticoagulation (p = 0.029) use, and a lower rate of alpha-blocker use (p = 0.0016). As expected, ASA scores which correlate with increasing number of concomitant diseases were greater in the ≥ 80 cohort (p = 0.016). There was no significant difference in intraoperative complications (p = 0.14), 90day complication (p = 0.34), readmission rates (p = 0.425) or emergency room visits between groups (p = 0.15). Despite higher medical comorbidities and increased rates of anticoagulation in octogenarians, there is no increase in operative or postoperative complication rates. Age alone should not be used as exclusion criteria for HoLEP.

Narrative Review of the Mechanism of Hip Prosthesis Dislocation and Methods to Reduce the Risk of Dislocation.

Total hip arthroplasty (THA) is one of the most effective surgical procedures. It improves quality of life, increases range of motion, and reduces pain in patients with hip joint degeneration. THA allows patients to return to everyday social and professional activities. Therefore, today it is the best approach to treatment of several chronic conditions affecting the hip joint, including advanced degenerative diseases, avascular necrosis, and some traumatic events. The aim of this study was to present the mechanism of hip prosthesis dislocation, associated risk factors, and the factors reducing the risk of dislocation, as well as its consequences and methods of risk minimization.Hip dislocation is a common complication following THA. It is responsible for up to 2% to 3% failures of primary replacements, increasing even to 10% in extreme cases of patients highly predisposed to this condition. In most cases, technical errors during implant placement are responsible for the incidence. The measures taken to prevent complications include activities aimed at correct implant insertion and the selection of the most appropriate type of implant for the patient, depending on individual needs.We summarized the current knowledge of implant dislocation to help surgeons understand the changes in biomechanics of the hip after its replacement and the impact of each particular element that participates in it. This knowledge can enable a surgeon choose the most favorable surgical method and the most appropriate implant to reduce the risk of implant dislocation.

Points to Consider Regarding Risk-Reducing Mastectomy in High-, Moderate-, and Low-Penetrance Gene Carriers.

Risk-reducing mastectomy is considered a safe and effective surgical procedure in high-risk individuals with BRCA1/2 germline mutations. Multigene panels identify women with alterations in breast cancer susceptibility genes other than BRCA1/2. International guidelines classify these genes as high-, moderate-, and low-penetrance based on their associated relative risk for breast cancer. Classification of specific genes is not always concordant among guidelines, and the indications for risk-reducing mastectomy are not defined. In this opinion paper, we review some considerations to clarify these controversial points.

Dá sa včasným pooperačným DWI zistiť reziduálny cholesteatóm?

Residual cholesteatoma results from an incomplete surgical removal of the cholesteatoma matrix. A variety of surgical procedures are used to remove cholesteatomas with varying success rates. In extensive cholesteatomas with minimal possibility of conductive system reconstruction, subtotal petrosectomy with blind sac closure is an effective surgical procedure. Diffusion-weighted magnetic resonance imaging (DWI) and ADC maps are used in the dia­gnosis of recurrent cholesteatoma. We present the case of a 40-year-old man, who repeatedly underwent revision surgeries for extensive cholesteatoma recidivism. An early postoperative DWI in the first days after the revision intervention did not show residual cholesteatoma. Surprisingly, a follow-up DWI detected the presence of cholesteatoma a few months later. The goal of this paper is to open the discussion on early postoperative DW MRI. Key words recidivism – residual and recurrent cholesteatoma – DWI – ADC map – subtotal petrosectomy – blind sac closure

Guided Bone Regeneration for The Treatment of Different Types of Bony Defects: A Literature Review

&lt;p&gt;Horizontal and vertical bone resorption after tooth extraction can adversely affect the success of a dental implant. Therefore, several ridge augmentation techniques, such as guided bone regeneration (GBR), bone block grafting, and ridge expansion, have been developed to provide sufficient bone volume around the implant and improve its stability and position. GBR is the most widely used technique for bone augmentation. However, because of the numerous surgical procedures and materials available, it is difficult to choose the most appropriate treatment. Efficient and effective surgical procedures and materials with low complication rates have been recommended for different types of bony defects, such as intra-alveolar, dehiscence, fenestration, horizontal, and vertical bony defects. This review summarizes the results of studies on various GBR techniques published in the English literature and discusses the most appropriate and predictable GBR techniques that can be used for the different types of bony defects.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions.

Treatment of urolithiasis, a benign disease, requires high efficacy and safety. Endoscopic treatment of impacted ureteral stones remains a challenging procedure for urologists, despite recent remarkable advances in surgical technology in treatment of urolithiasis. The success rate of endoscopic treatment in patients with impacted stones is reported to be lower than that in patients with nonimpacted stones. Moreover, the presence of stone impaction is associated with high rates of intraoperative and postoperative complications. The best management for patients with impacted ureteral stones should therefore be devised based on the latest knowledge and techniques. The present review focuses on the preoperative prediction of stone impaction, the safest and most effective endoscopic surgical procedures, and the most appropriate management for postoperative ureteral strictures. We overview comprehensive endoscopic management for impacted ureteral stones based on literature review and expert opinions.

Duodenal Switch Combined with Systematic Post-operative Supplementation and Regular Patient Follow-up Results in Good Nutritional Outcomes.

The duodenal switch is the most effective bariatric surgical procedure. Due to technical demands of the surgery and concerns regarding high rates of post-operative nutritional sequelae, many surgeons remain hesitant to adopt this technique. Sixty-five patients undergoing duodenal switch surgery at our hospital between 2008 and 2015 were followed up for 5years. All patients were provided with a thorough post-operative nutritional supplementation regimen. Nutritional deficiencies as evidenced by blood testing, excess body weight loss, and remission rates from type 2 diabetes, hypertension, and dyslipidaemia were studied. The average excess body weight loss 5years post-operatively was 62% ± 23.03%. Remission rates for type 2 diabetes, hypertension, and dyslipidaemia were 96%, 77% and 84% respectively. Patients achieved good nutritional outcomes. After 5years, deficiencies in fat-soluble vitamins A and D occurred in 3.3% and 1.6% of patients respectively. The rate of ferritin deficiency at the 5-year post-operative mark was 19.4%. No predictors of nutritional deficiency were identified on univariate analysis. Patients undergoing a duodenal switch achieve good long-term excess body weight loss and high obesity-related co-morbidity remission rates. The rates of post-operative nutritional deficiencies in patients who are subjected to a thorough post-operative nutritional supplementation regimen are lower than what was historically expected.

Revision Open Subpectoral Biceps Tenodesis With Allograft Tendon Reconstruction for Symptomatic Failed Biceps Tenodesis

Biceps tenodesis and tenotomy are both effective surgical procedures for management of shoulder pain and dysfunction secondary to SLAP tears, biceps tendinitis, rotator interval pulley lesions, and failed SLAP repairs. These procedures are generally safe with low complication rates. However, failure of a proximal biceps tenodesis or tenotomy can rarely lead to symptomatic Popeye deformity with pain and cramping with repetitive forearm supination and elbow flexion. Surgical revision is indicated in young active patients to restore the length tension relationship of the biceps brachii to improve supination and flexion strength, as well as to provide symptomatic relief and improved endurance. Failed biceps tenodesis can be a challenging surgical scenario, as oftentimes there is limited available proximal biceps tendon tissue, especially in the setting of prior subpectoral biceps tenodesis. We report a technique of revision open subpectoral biceps tenodesis with allograft tendon augmentation for the management of symptomatic Popeye deformity in young active patients with little to no remaining proximal biceps tendon.

Long-Term Outcomes of Excimer Laser-Assisted Penetrating Keratoplasty Using a Commercially Available Laser System - A Retrospective Case Series.

Favorable functional outcomes have been reported after excimer laser-assisted penetrating keratoplasty (EXL PKP). But this technique has not been widely adopted, and there are reports on EXL PKP from only a very limited number of institutions. Some of these results refer to operations carried out with laser systems that are not commercially available. In this retrospective case series, we report the long-term outcome of EXL PKP using the Schwind Amaris 500E laser system. This retrospective consecutive case series included 30 eyes of 29 patients who had undergone EXL PKP between 2010 and 2013. Primary outcome measures were topographic astigmatism and visual acuity. Secondary outcome measures were the rates of graft rejection and graft failure, and the rate of grafts with an endothelial cell density below 500 cells/mm2. Survival analyses were carried out for the following endpoints: visual acuity, rate of graft rejection, and rate of grafts with endothelial cell densities higher than 500 cells/mm2. The median interquartile range (IQR) duration of follow-up was 45 (36) months. The indications for PKP were keratoconus (n = 21), corneal scarring (n = 6), Fuchs endothelial dystrophy (n = 1), and corneal dystrophy other than Fuchs endothelial dystrophy (n = 2). The median (IQR) topographic astigmatism at the end of the follow-up period was 5.3 (2.9) D. Forty-five months after surgery, 73% of all eyes had a visual acuity better than 0.3 LogMAR. The rate of graft rejection after 45 months of follow-up was 32%. All eyes maintained endothelial cell densities higher than 500 cells/mm2. There was no graft failure. EXL PKP is a safe and effective surgical procedure. No general conclusions can be drawn on the refractive outcome of EXL PKP. Potential advantages, such as a higher degree of graft-host congruity, that could possibly improve the refractive outcome should be weighed against the higher costs of EXL PKP.

Idiopathic Aqueductal Stenosis: Late Neurocognitive Outcome in ETV Operated Adult Patients.

ObjectiveThe aim of the present study is to evaluate a neurocognitive outcome in patients affected by late-onset idiopathic aqueductal stenosis (LIAS) who underwent endoscopic third ventriculostomy (ETV).Materials and MethodsA prospective study was conducted between January 2015 and December 2017 in a series of 10 consecutive adult patients referred to the Neurosurgery Department of IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. All the adult patients admitted with absence of CSF flow through the aqueduct in phase-contrast (PC)—MRI sequences or a turbulence void signal in T2—weighted images in midsagittal thin-slice MR sequences underwent a specific neuroradiological, neurological, and neurocognitive assessment pre- and postoperatively.ResultsAll patients affected by gait and sphincter disturbances improved after ETV. Attentive and executive functions as well as visuo-spatial memory and verbal executive functions improved in several patients. Similarly, the affective and behavioral scales improved in almost 50% of the patients. No major complications have been recorded, and no patients required a second surgery for shunt placement.ConclusionEndoscopic third ventriculostomy represents a safe and effective surgical procedure for the treatment of LIAS. In addition to neurological improvement, we demonstrated also postoperative neurocognitive improvement mainly in attentive and executive functions, visuo-spatial memory, verbal executive functions, and behavioral and affective domains.

Statistical modelling of how the sagittal alignment of the cervical spine is affected by adolescent idiopathic scoliosis and how scoliosis surgery changes that.

The relationship between the sagittal shape of the cervical spine and that of the thoracolumbar spine is established in the normal spine. Adolescent idiopathic scoliosis (AIS) is recognised as a change in the shape of the spine in both the coronal and sagittal planes. The effects of AIS on the alignment of the cervical spine, including the effects of surgery, has been less well studied. The objective of this study was to identify, using regression analysis, the significant relationships between the alignment of the thoracolumbar spine, in both the coronal and sagittal planes, and the sagittal alignment of the cervical spine in AIS. This study used coronal and sagittal radiographic measures from a group with AIS, both pre and post-operatively, which were analysed using multiple linear regression methods to identify significant parameters that explain the sagittal shape of the cervical spine. There were 51 pairs of pre and post-operative radiographs analysed, 40 of which were Lenke 1 curves and 11 Lenke 3 curves. Posterior spinal fusion was performed for all. The significant parameters pre-operatively were T1 slope, thoracic kyphosis, lumbar lordosis and SVA with an R2 value of 78%. Post-operatively, the significant parameters were T1 slope, thoracic kyphosis, lumbar lordosis and thoracolumbar scoliosis with an R2 of 63%. The sagittal alignment of the cervical spine in AIS is related to the shape of key parameters in the rest of the spine. Changes in the cervical sagittal shape occur to compensate for changes in shape to the rest of the spine that occur as a consequence of surgery. This has implications for the understanding of how the compensatory mechanisms of the spine are used to maintain a horizontal gaze, along with prediction of the effects of surgery on the shape of the spine.

Comparison of Percutaneous Endoscopic Interlaminar Discectomy and Open Fenestration Discectomy for Single-Segment Huge Lumbar Disc Herniation: A Two-year Follow-up Retrospective Study.

PurposeBoth percutaneous endoscopic lumbar discectomy (PELD) and open fenestration discectomy (OFD) are effective and safe surgical procedures for the treatment of LDH. The purpose of this retrospective study was to compare the surgical outcomes of percutaneous endoscopic interlaminar discectomy (PEID) and OFD for single-segment huge lumbar disc herniation (HLDH).Patients and MethodsWe retrospectively analyzed 91 patients diagnosed with single-segment HLDH and treated with OFD or PEID. Visual analog scale (VAS), modified Japanese orthopedic association (mJOA) and Oswestry disability index (ODI) were used to assess clinical outcomes at preoperation and postoperatively at 3, 6, 12, and 24months. Modified Macnab criteria were applied to evaluate clinically satisfaction at the final follow-up.ResultsIn both groups, the VAS and ODI scores at 3, 6, 12, and 24months postoperatively showed a significant decrease and the mJOA score at 3, 6, 12, and 24months postoperatively was significantly increased compared to preoperative results (P<0.001). According to Macnab criteria at the final follow-up, the overall clinically satisfactory rate was 86.67% in the OFD group and 86.96% in the PEID group. There were no significant differences in VAS, ODI, and mJOA scores between the two groups at preoperation and postoperative 3, 6, 12, and 24months, respectively. In the PEID group, the length of hospitalization and the length of incision were significantly shorter than that in the OFD group (P<0.0001). However, there was no significant difference in operative time between groups (P=0.81).ConclusionCollectively, postoperative clinical results were equally favorable for both procedures, with no statistically significant difference between PEID and OFD at the two-year of follow-up. No serious complication was observed in two groups. Compared with the traditional surgery, PEID has the following benefits: less trauma, less bleeding, speedy recovery, and shorter hospitalization. Therefore, PEID may be a promising alternative to traditional surgery.

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

Laparoscopic abdominal cerclage during pregnancy: a simplified approach

Cervical insufficiency is a major cause of second-trimester pregnancy loss and spontaneous preterm delivery. Transabdominal cervicoisthmic cerclage is usually performed before pregnancy for patients of cervical insufficiency, in whom transvaginal cervical cerclage procedure cannot be placed or has failed previously. Performing a transabdominal cerclage becomes a huge challenge owing to the enlargement of the pregnant uterus in patients who were indicated for transabdominal cervicoisthmic cerclage but were missed before pregnancy. Here, we have outlined an easy and effective surgical procedure as needle-free laparoscopic trans-broad-ligament cervicoisthmic cerclage during early second-trimester. Laparoscope with 4 trocars was established, after expanding the trigonum of ureter, ovarian vascular and ascending branch of uterine artery. The needleless Mersilene tape was inserted in a posterior-to-anterior direction of bilateral trigonums, tightening the knot toward the bladder uterine reflection and simultaneously pushing the loop behind the uterus, directed to the cervix progressively. The tape was then tied anteriorly at the cervico-isthmic junction with 5 to 6 intracorporeal square knots after transvaginal ultrasound determined the presence of systolic velocity of uterine artery with first knot. The primary feature of our procedure was that the needleless Mersilene tape was inserted centrally from the broad ligaments, lateral to the uterine vessels, and finally tied above the uterosacral ligament at the level of the uterine isthmus, without dissecting the bladder off from lower uterine segment and without separating the uterine vessels from the lateral wall of the cervix. We performed this procedure on 10 patients with pregnancy outcomes and there was no pregnancy loss. This procedure proved to be an accessible and effective surgical technique for transabdominal cerclage of the uterine cervix during early-second trimester, with affirmative prognosis.

Investigating men's motivations to engage in genetic screening for BRCA1 and BRCA2 mutations.

BRCA1 and BRCA2 mutations are associated with an increased risk of developing numerous cancers, including breast, ovarian, pancreatic, melanoma and prostate cancer. Men face BRCA-related cancer risks as women do. However, there is considerably less research on the psychological determinants of men engaging in BRCA1/2-related cancer prevention compared to women. The present research aimed to study the determinants of men’s motivations to engage in genetic screening for BRCA1 and BRCA2 through the lens of the Health Action Process Approach. One hundred and twenty-five men (mean age = 58.53 y/o, SD = 10.37) completed an online survey. The intention to undergo genetic screening for BRCA1/2 mutations in men was significantly and positively associated with self-efficacy and risk perception. Moreover, having offspring positively affected intention as well. The relationships between intention (and planning) and positive outcome expectancies, age, and family history of breast-related cancer were not statistically significant. Most information on BRCA1 and BRCA2 mutations is tailored to women due to the availability of effective surgical risk reduction procedures for women’s breast and ovarian cancer. Future research should focus on the best methods of communicating informed decision-making for men facing the risk of such mutations.

Impact of preoperative staging with contrast-enhanced mammography for localized breast cancer management.

A precise evaluation of the disease extent is mandatory before surgery for early breast cancer (EBC). Contrast-enhanced mammography (CEDM) is a recent technique that may help define adequate surgery. This retrospective study included consecutive patients referred to a cancer center between November 2016 and July 2017 for biopsy-confirmed invasive EBC management. The primary objective was to evaluate the rate of surgical changes after incorporating the results of the preoperative staging examination, including CEDM. A total of 231 patients were screened for inclusion, and 132 patients were included, corresponding to 134 lesions. The first surgical plan was modified for 33 patients (25%), which represented 34 lesions. For 8 patients (6%), the surgery was cancelled in preference for neoadjuvant chemotherapy; for 16 patients (12.1%), the primary tumor procedure was enlarged; and for 23 patients (17.4%) the lymph node management was modified. Surgery was changed only due to the CEDM results for 24 patients (18.5%) and consisted of a more invasive procedure due to a more extended, multifocal or multicentric lesion than seen on the standard imaging. Anatomopathological surgery piece findings were well correlated with contrast-enhanced mammography results. Overall, there was no increase in the delay between the planned date of surgery and the effective surgical procedure (median 0 days). CEDM added to preoperative staging helped define better surgical management without increasing delay in the surgical procedure. CEDM is a reliable technique that should be considered as part of preoperative staging for EBC.

Early aseptic loosening of the tibial component at the cement-implant interface in total knee arthroplasty: a narrative overview of potentially associated factors.

Total knee arthroplasty (TKA) is a highly effective surgical procedure, but in some patients TKAs fail early due to a variety of underlying factors. About 11% of revision TKAs within one year of primary TKA are the result of aseptic loosening of the tibial component at the cement-implant interface. Literature regarding the most important factors associated with this type of loosening is scarce. The objective is to give an overview of the literature regarding factors associated with aseptic loosening of the tibia component at the cement-implant interface in total knee arthroplasty. A narrative literature review based on publications identified through PubMed and CINAHL databases. Twelve studies were identified, which describe a total of 299 cases of early aseptic loosening of the tibia component at the cement-implant interface. The main associated factors reported were cementa- tion factors. These factors included the use of high viscosity cement (HVC), cement application methods and cement thickness. Other main reported associated factor related to implant design factors, which included component shape and surface roughness. The least frequently reported associated factors related to the patient characteristics of body mass index (BMI). Several factors associated with early aseptic loosening of the tibial component at the cement-implant interface in total knee arthroplasty were identified in this review. The most frequently reported associated factors related to cementation factors and implant design factors. Because the literature in this area is scarce, further research is warranted in an effort to prevent early aseptic loosening in future TKAs.

COMPARISON OF UTILITY SCORES OF HIP ARTHROPLASTY FOR DYSPLASTIC OSTEOARTHRITIS

Purpose: This study aimed to compare the utility score of dysplastic osteoarthritis of the hip (OA) after different surgical treatments. Methods: In this cross-sectional study, we evaluated the utility scores of 204 patients using the Short Form-6 Dimension. Results: Utility scores of all surgery types were significantly higher than those preoperatively in OA ([Formula: see text]). The utility scores of the unilateral primary total hip arthroplasty (THA) were significantly higher than those of the revision THA. Conclusions: Although THA and osteotomy are effective surgical procedures, lifetime treatment plans should be considered to avoid revision surgery as far as possible.