Good Short-term Outcomes Research Articles

Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a propensity score matching analysis

Surgical resection is a first-line curative option for hepatocellular carcinoma, but its role is still unclear in elderly patients. The aim of our study was to compare short- and long-term outcomes of laparoscopic and open liver resection in elderly patients with hepatocellular carcinoma.The study included 665 consecutive hepatocellular carcinoma liver resection cases in patients with ≥70 years of age treated in eight European hospital centres. Patients were divided into laparoscopic and open liver resection groups. Perioperative and long-term outcomes were compared between these groups.After a 1:1 propensity score matching, 219 patients were included in each group. Clavien-Dindo grades III/IV (6 vs. 20%, p = 0.04) were lower in the laparoscopic than in the open matched group. Hospital stay was shorter in the laparoscopic than in the open matched group (5 vs. 7 days, p < 0.001). There were no significant differences between laparoscopic and open groups regarding overall survival and disease-free survival at 1-, 3- and 5- year periods.Laparoscopic liver resection for hepatocellular carcinoma is associated with good short-term outcomes in patients with ≥70 years of age compared to open liver resection. Laparoscopic liver resection is safe and feasible in elderly patients with hepatocellular carcinoma.

Approaches and strategies to manage the hepatitis C virus-positive heart donor

Cardiac transplantation remains the treatment of choice for patients with advanced heart failure, but is limited by a donor organ shortage. Utilization of hepatitis C virus (HCV)-positive donors has been recently adopted to expand access to heart transplantation. We review the history of HCV heart transplantation, modern drug therapy, and recent outcomes. Since the advent of direct-acting antiviral (DAA) therapy, several single-center studies, and retrospective reviews have demonstrated good short-term outcomes, shorter waitlist times, and clearance of viremia with recipients of HCV-positive hearts. Two principle approaches to treatment of recipients of HCV viremic donors are utilized. In the prophylactic strategy, therapy is initiated before viremia is detected compared with the preemptive approach where initiation of DAA is delayed until after viremia is detected. Future studies are needed to address uncertainty about medium and long-term outcomes of using HCV-positive hearts and to determine the optimal treatment timing and duration. Utilization of HCV-positive donors has expanded the heart donor pool and appears safe through the early posttransplant period. We suggest that prophylactic administration of the shortest effective course of a DAA pangenotypic agent should be the current standard of care.

Immediate and Short-Term Variations in the Echocardiographic Cardiac Hemodynamic Parameters after the Transcatheter Atrial Septal Defect Device Closure and its Procedural Success.

Background and Aims:Transcatheter closure of the secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. We aimed to analyze and compare the changes in cardiac hemodynamics with transthoracic echocardiography (TTE) before, within 48 hours, and after 3 months of ASD closure.&#x0D; Methods: This was a prospective, single-centered study of 43 patients who underwent ASD device closure in the Manmohan Cardiothoracic Vascular and Transplant Center during June 2020 to June 2021 with Amplatzer Septal Occluder under transesophageal and fluoroscopic guidance. The patients were evaluated with TTE before, at 48 hours, and 3 months after the procedure.&#x0D; Results: At 48 hours and 3 months of device closure, the right atrial major dimension, the maximum blood flow velocity at the pulmonary valve orifice, mean flow velocity, velocity time integral, and E peak and A peak blood flow velocity at the tricuspid valve orifice were significantly reduced (P &lt; 0.001). At 3 months, the dimensions and ejection fraction of the left ventricle showed significant increment (P &lt; 0.001). Likewise, the right atrial minor dimension and area, right ventricular basal, mid, and longitudinal dimensions, tricuspid annular plane systolic excursion, right ventricular Tei Index, and fractional area change were significantly reduced (P &lt; 0.001). The main pulmonary artery diameter, pulmonary artery systolic and mean pressure, and the pulmonary vascular resistance and index were significantly reduced (p &lt;0.001). The procedural success rate was 97.6%.&#x0D; Conclusion: Echocardiographic evaluation demonstrated that cardiac hemodynamics and loading conditions improved significantly at 3 months after percutaneous closure of ASD. The transcatheter closure of ASD was safe with good short-term outcomes.

Midterm Outcomes of Talocalcaneal Coalition Arthroscopic Resection in Adults.

Arthroscopic resection of the talocalcaneal coalition (TCC) has been reported to be associated with good short-term outcomes. However, the midterm outcomes of this approach remain uncertain. We performed a retrospective study of patients who underwent arthroscopic resection for symptomatic TCC. The patients were divided into 2 groups (group P, patients with isolated posterior facet coalition; and group MP, patients with both middle and posterior facet coalition). The preoperative and postoperative visual analog scale (VAS) scores for pain and American Orthopaedic Foot & Ankle Society (AOFAS) scale scores were calculated. The postoperative AOFAS and VAS scores between the 2 groups were analyzed. Patient satisfaction was also assessed. Thirty-two patients were included in this study. The mean age at the time of surgery was 26.0±8.5 years, and the mean follow-up period was 56.9±18.0 months. Thirteen (41%) patients were in group P, whereas 19 (59%) patients were in group MP. Postoperative VAS and AOFAS scores improved more significantly than preoperative scores. At the final follow-up, excellent and good subjective outcomes were attained in 26 patients (81%), fair and poor outcomes in 6 patients (19%). There were no statistical differences in the postoperative AOFAS (91.0±7.0 vs 85.8±10.8, P = .532) and VAS score (2.1±1.7 vs 4.0±2.6, P = .537) between patients with the ratio of coalition/posterior facet more than or less than 50%. There were no statistical differences in postoperative VAS score (1.8±1.3 vs 2.6±2.2, P = .236) and AOFAS score (92.5±5.6 vs 89.2±8.7, P = .297) between group P (n=13) and group MP (n=19), either. Three patients (9.4%) had complications, including these notable findings: 1 patient complained of restricted dorsal flexion, 1 with computed tomography-proven coalition recurrence, and 1 with partial tibial nerve injury. We found that TCC arthroscopic resection was generally associated with reasonable outcomes at midterm follow-up. Level IV, case series.

Outcomes following prenatal diagnosis of isolated persistent left superior vena cava

Prenatal diagnosis of persistent left superior vena cava is increasing, but little is known about outcomes of infants with prenatally diagnosed isolated persistent left superior vena cava. To assess the outcomes of infants with isolated persistent left superior vena cava diagnosed prenatally compared with infants with associated malformations. All cases of persistent left superior vena cava confirmed by specialized fetal echocardiography in pregnant women were included from a single-centre prospective registry. Unfavourable outcome was defined as termination of pregnancy, in utero death, postnatal death or severe genetic syndrome missed prenatally. A total of 256 infants were included: 113 cases (44.1%) with isolated persistent left superior vena cava and 143 cases (55.9%) with associated malformations; respectively, 111 (98.2%) and 101 (70.6%) had a live birth. The median postnatal clinical follow-up was 3.6 years. Five-year postnatal survival with good outcome was estimated at: 100% (95% confidence interval 90.7% to 100%) in infants with isolated persistent left superior vena cava; 91.0% (74.0% to 98.1%) in infants with associated cardiac anomalies; 87.5% (51.8% to 97.3%) in infants with associated extracardiac anomalies; 81.0% (52.6 to 94.6%) in infants with both cardiac and extracardiac anomalies; and 78.9% (36.7% to 95.9%) in infants with non-structural anomalies. All genetic findings and syndromes were detected in fetuses or infants with non-isolated persistent left superior vena cava. Infants with isolated persistent left superior vena cava have good short-term outcomes postnatally, but persistent left superior vena cava is frequently associated with other malformations that have an effect on outcomes, which should be thoroughly searched for prenatally.

MP25-20 DEMUSOCALIZED DETRUSOR MUSCLE FLAPS FOR COMPLEX URETHRAL FISTULA

You have accessJournal of UrologyCME1 May 2022MP25-20 DEMUSOCALIZED DETRUSOR MUSCLE FLAPS FOR COMPLEX URETHRAL FISTULA Matthew Loecher, Ramphis Morales-Lopez, and Michael Metro Matthew LoecherMatthew Loecher More articles by this author , Ramphis Morales-LopezRamphis Morales-Lopez More articles by this author , and Michael MetroMichael Metro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiation associated rectourethral (RUF) and urosymphyseal fistulas (USF) are complex urologic problems that often require permanent urinary diversion. While reconstruction for RUF and USF have been studied in small case series with good short-term outcomes, little information exists on the optimal approach when reconstruction fails or is not feasible. We present a novel approach to fistula management with subtotal cystectomy with urinary diversion and creation of demucosalized detrusor muscle flaps (DDMF) for pelvic interposition. We propose that this technique optimizes reconstructive principles to improve wound healing and eliminate empty space in a hostile and infected field. METHODS: We performed a retrospective review of eight patients with radiation-associated USF or RUF treated with subtotal cystectomy with DDMFs and ileal conduit performed by a single surgeon between January 2018 and October 2021. Surgical technique and preoperative work up was described (Figure 1). Preoperative data, radiation history and prior interventions were collected. Short-term outcomes and peri-operative complications were recorded (Table 1). RESULTS: All men had been treated for prostate cancer with radiation therapy without evidence of biochemical recurrence. TUR of a BNC was the most common inciting factor. Median age was 76.5 years old (range 71-81). Mean length of stay was 9.5 days. Median follow up was 13.5 months (range 4-24). All USF patients have not had reoccurrence of pelvic sepsis or pubic osteomyelitis at follow up. All RUF patients had been able to re-establish bowel continuity. Thirty-day post-operative complications were all Clavien-Dindo 1 or 2. CONCLUSIONS: DDMFs are a safe and feasible option for patients who fail or are not candidates for definitive reconstruction of RUF or USF. We propose that using vascularized muscle flaps allows for tissue interposition without added morbidity, need for distant muscle flaps or need for plastic surgery consultation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e436 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Loecher More articles by this author Ramphis Morales-Lopez More articles by this author Michael Metro More articles by this author Expand All Advertisement PDF DownloadLoading ...

Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction? Five-Year Results of a Randomized Controlled Clinical Trial

Background: High-level evidence for short–term outcomes of contemporary anterior cruciate ligament (ACL) suture repair (ACLSR) in comparison with those of ACL reconstruction (ACLR) is scarce. High-level evidence for mid- and long–term results is lacking, whereas outcomes of ACLSR in several historical studies were shown to deteriorate at midterm follow–up after initial good short–term outcomes. Hypothesis: Contemporary ACLSR is noninferior to ACLR in the treatment of acute ACL rupture in terms of patient self–reported outcomes at 5 years postoperatively. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 48 patients were enrolled in the study and, after stratification and randomization, underwent either dynamic augmented (DA) ACLSR or anatomic single–bundle ACLR. The primary outcome measure was the International Knee Documentation Committee 2000 (IKDC) subjective score (IKDCs). Furthermore, the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale score (TAS), visual analog scale score for satisfaction (VASs), IKDC physical examination score (IKDCpe), limb symmetry index for quadriceps (LSIq) and hamstrings (LSIh) strength and jump test battery (LSIj), Kellgren-Lawrence grade of osteoarthritis (OA), and rate of adverse events were recorded. Analyses were based on an intention–to–treat principle. Results: The lower limit of the 2–sided 95% CI for the median IKDCs of the DA ACLSR group (n = 23; 75.9) was lower than the prespecified noninferiority margin (n = 21; 86.6). Therefore, the null hypothesis was rejected. However, the upper limit of the 2–sided 95% CI of the DA ACLSR group (100.0) was higher than the median IKDCs of the ACLR group (96.6), rendering the result for noninferiority inconclusive. No statistical difference was found between groups for median IKDCs (repair, 90.2; reconstruction, 96.6). Furthermore, no statistically significant differences were found for any of the secondary outcome measures for the DA ACLSR compared with the ACLR group: KOOS Symptoms, 92.9 versus 96.4; KOOS Pain, 100 versus 97.2; KOOS Activities of Daily Living, 100 versus 100; KOOS Sport and Recreation, 85.0 versus 100; TAS score, 7.0 versus 6.5; VASs, 9.2 versus 8.7; IKDCpe, 81.8% versus 100%; LSIq, ≥91.6 versus ≥88.2; LSIh, ≥95.1 versus ≥90.7; LSIj, ≥94.2 versus ≥97.6; OA grade 0, 90.9% versus 77.8%; clinical ACL failure rate, 20.8% versus 27.2%; and repeat surgery rate, 37.5% versus 20.0%, respectively. Conclusion: It remains inconclusive whether the effectiveness of DA ACLSR is noninferior to that of ACLR in terms of subjective patient–reported outcomes as measured using the IKDCs. Although DA ACLSR may be a viable treatment option for patients with acute ACL rupture, caution must be exercised when considering this treatment for young, active patients, corresponding to the present study population.

The Classification and Surgical Treatments in Adult Hirschsprung's Disease: A Retrospective Study.

PurposeTo explore the treatments and short-term effects of different types of adult Hirschsprung’s disease.Methods89 patients treated in Shanghai Changhai Hospital were retrospectively analyzed. According to the patient’s medical history, clinical manifestations, auxiliary examination and postoperative pathological results, the patients were divided into adult congenital megacolon, adult idiopathic megacolon, ganglion cell deficiency (types I and II), toxic megacolon and iatrogenic megacolon, The Treatment methods and short-term prognosis of patients in each group were summarized.Results41 cases of Hirschsprung’s disease in adults and low anterior resection or pull-out low anterior resection was performed, and 35 patients with idiopathic Megacolon were treated with one-stage subtotal colon resection under the condition of adequate preoperative preparation. Some patients admitted for emergency intestinal obstruction received conservative treatment first or underwent elective surgery after colonoscopic decompression was improved; two patients with ganglion cell deficiency subtotal colectomy were performed to remove the dilated proximal bowel segment and the narrow distal bowel segment; three patients with toxic Hirschsprung’s disease underwent colostomy in mild cases, while subtotal colorectal resection was required in severe cases; Iatrogenic megacolon was diagnosed in eight cases and the optimum operation should be selected according to the specific conditions of patients.ConclusionAdult Hirschsprung’s diseases were divided into adult congenital hirschsprung’s disease, idiopathic Hirschsprung’s disease, ganglion cell deficiency, toxic hirschsprung’s disease, and iatrogenic Hirschsprung’s disease. Different types of surgical treatments for Hirschsprung’s disease in adults should be selected according to the specific diagnosis. All patients with adult Hirschsprung’s diseases have good short-term outcomes after surgical treatment.

Safety and Feasibility of Soractelite Transperineal Focal Laser Ablation for Prostate Cancer and Short-term Quality of Life Analysis from a Multicenter Pilot Study

BackgroundSoractelite™ transperineal focal laser ablation (TPLA) for the treatment of localized prostate cancer (PCa) using the Echolaser® system is a novel minimally invasive technique that has the potential to induce tissue ablation, while reducing treatment-related morbidity, when compared with robot-assisted radical prostatectomy (RARP) and radiotherapy. ObjectiveTo determine the short-term safety and feasibility of single or multifiber TPLA, its functional outcomes, and quality of life (QoL). Design, setting, and participantsTPLA was performed in 12 patients, consecutively assigned to four treatment regimens, with localized PCa who were scheduled for RARP (“ablate and resect design”). The treatment regimens were as follows: (1) a single fiber at 3 W, (2) two fibers at 5 mm distance at 3 W, (3) two fibers at 10 mm distance at 3 W, and (4) a single fiber at 5 W. TPLA was scheduled 4 wk prior to RARP. InterventionTPLA using the Echolaser® system under local anesthesia at the outpatient clinic. Outcome measurements and statistical analysisSafety and feasibility were determined by the assessment of device-related peri- and postoperative adverse events (AEs), and length of hospital stay. Functional outcomes and QoL were measured using validated questionnaires. Feasibility of RARP was assessed by a questionnaire for the urologist. Results and limitationsPatients were dismissed after a median (interquartile range) hospital admission of 3.25 (1.25) h. No device-related AEs occurred. AEs that occurred were mostly related to lower urinary tract symptoms and were mild (grade 1–2). Most AEs resolved within 1 wk. A QoL analysis showed no significant differences for all treatment regimens. Functional outcomes remained unchanged, except for erectile function after 1 wk, which returned to baseline after 4 wk. TPLA treatment did not compromise RARP, based on the questionnaires. ConclusionsTPLA for the treatment of PCa at the outpatient clinic appears to be safe and feasible with good short-term QoL and functional outcomes; oncological results are awaited. Patient summaryFocal treatment of localized prostate cancer can safely be performed in a daycare setting using a new technique, based on laser ablation, without compromising quality of life.

Using Donor Lungs ≥70 Years of Age for Transplantation - Do Long-Term Outcomes Justify the Use?

<h3>Purpose</h3> Donor shortage have led transplant centers in the past to extend acceptable criteria for lung donors, accepting older and more marginal donor organs for transplantation. Accepting donors ≥70 years of age as lung donors has shown good short-term outcomes in the past, however, no mid- and long-term outcome data on these extended criteria donors exists thus far. <h3>Methods</h3> All patients undergoing lung transplantation between 06/2010 and 12/2019 at our institution were included into the analysis, that compared outcomes between patients transplanted with donors <70 years of age vs. patients transplanted with donors ≥70 years old. Outcome parameters included pre-, peri- and postoperative clinical parameters as well as recipient overall survival and CLAD-free survival. Median follow-up was 8.9 years. <h3>Results</h3> Between 06/2010 and 12/2019, among the 1168 lung-transplanted patients, 62 (5.3%) patients received lungs from donors ≥70 years old. Recipient age of the patients receiving older organs was significantly higher as compared to recipients of <70 years old lungs (56.2±7.8 vs. 48.7±38.9 yrs; p<0.0001) and more patients with an obstructive disease pattern prior to transplantation received a donor lung ≥70 years old (40.3% vs. 27.6%; p=0.04). Mean donor age was 73.4±2.9 years in the ≥70 years old group as compared to 44.3±15.8 yrs in the other cohort (p<0.0001). Older donors were significantly shorter on mechanical ventilation prior to donation (4.0±3.6 vs 5.7±5.1 days; p=0.0007), had a higher median Horowitz index (412.5 (356;469) vs. 384 (316; 448); p=0.01) and fewer history of smoking (12.9% vs. 42.1%; p<0.0001).Primary graft dysfunction scores at 24 (p=0.99), 48 (p=0.60) and 72 (p=0.94) hours after transplant showed no significant difference between both groups. Similarly, time on mechanical ventilation (p=0.68), time on ICU (p=0.65) as well as total hospital stay (p=0.58) were comparable in both groups. One-, five- and 7-year survival in both groups showed no significant difference (1yr: 95.1 vs. 90.2%, 5yr: 77.8 vs. 73.2%, 7yr: 69.1 vs. 68.1%, p=0.71). CLAD-free survival showed no difference between both groups in the follow-up period (p=0.76). <h3>Conclusion</h3> Utilization of donor lungs ≥70 years of age leads to excellent mid- and long-term results that are similar to younger donor organs when carefully preselecting these older donor organs.

Irreversible Electroporation of Carcinoma of the Prostate Gland with a Focus on Localized Carcinoma of the Prostate Gland: A Review and Update

Irreversible Electroporation of Carcinoma of the Prostate Gland with a Focus on Localized Carcinoma of the Prostate Gland: A Review and Update

Laparoscopic liver resection for liver metastasis of leiomyosarcoma of the thigh: a case report

BackgroundAlthough there is no established treatment strategy for liver metastasis of leiomyosarcoma, liver resection has been reported to be effective in some cases. However, almost all liver resections performed for liver metastasis of primary leiomyosarcoma are reported to be open resections, and there are few reports of liver resection performed by laparoscopy. Here, we report a case of laparoscopic liver resection for liver metastasis of a leiomyosarcoma in the right thigh.Case presentationAn 80-year-old man was diagnosed with leiomyosarcoma of the right thigh with liver metastasis. The primary tumor was first resected, and he was discharged on the 25th postoperative day. Four months after primary tumor resection, a laparoscopic right posterior sectionectomy was performed. There were no postoperative complications, and the patient was discharged on the 11th postoperative day with a histopathological diagnosis of liver metastasis of leiomyosarcoma and negative resection margins. Currently, 9 months have passed since the resection of the primary tumor, and 5 months have passed since the laparoscopic liver resection; there is no recurrence.ConclusionsThe liver metastasis of leiomyosarcoma was successfully removed, with good short-term outcomes after the laparoscopic liver resection. Laparoscopic liver resection seems to be effective for liver metastasis of leiomyosarcoma, which is characterized by a high recurrence rate after surgery. However, more case studies may be necessary to examine the effectiveness and long-term results of laparoscopic liver resection for the treatment of liver metastasis of leiomyosarcoma.

Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction.

Background:Lateral meniscus posterior root tears (LMPRTs) almost always occur in association with anterior cruciate ligament (ACL) tears. Their repair is advocated to restore the stabilizing and load-sharing functions of the meniscus.Purpose:To study the functional outcomes of combined arthroscopic repair of LMPRTs and ACL reconstruction (ACLR).Study Design:Case series; Level of evidence, 4.Methods:The authors evaluated patients who underwent simultaneous arthroscopic ACLR and LMPRT repair. All patients had chronic injuries, with a mean time since ACL rupture of 7.9 months. Patient characteristics, Lachman and pivot-shift test results, type of LMPRT, associated injuries, and surgery details were documented. Pre- and postoperative functional status was assessed using the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. An independent single-tunnel transtibial repair using 2 SutureTapes was performed for Forkel type 1 and 3 tear root avulsions, while side-to-side suture repair was performed for type 2 radial/oblique tears. The Wilcoxon signed rank test and minimal clinically important difference (MCID) of the IKDC score were used for statistical analysis.Results:Included were 25 patients with a mean age of 29.6 ± 6.5 years. Of these, 22 patients (88%; 95% CI, 73.1%-100%) had a high-grade (grade 2 or 3) preoperative pivot shift. Diagnosis of the LMPRT on magnetic resonance imaging (MRI) scans was possible only in 5 patients (20%). At final evaluation, performed at 37.4 ± 7.1 months postoperatively, all functional scores had improved significantly from preoperatively: IKDC score, from 47.6 ± 9.5 to 81.8 ± 11.5; KOOS, from 45.5 ± 10.9 to 86.5 ± 10.3, and Lysholm score, from 49.0 ± 11.5 to 88.8 ± 7.6 (P < .001 for all). Twenty-four patients (96%) achieved the MCID for the IKDC score. All knees had a negative pivot shift at final analysis, and no patient underwent revision ACLR or LMPRT repair.Conclusion:LMPRT repair combined with ACLR led to good short-term clinical outcomes in this study. An LMPRT may frequently go undetected on preoperative MRI scans, but a high-grade pivot shift is present in a large majority of these patients.

Midterm results of arteriovenous fistula patency at Dong Nai General Hospital

Background: End-stage renal disease (ESRD) has dramatically increased in number and hemodialysis remains the main therapy. Arteriovenous fistula plays a critical role for dialysis patients. &#x0D; Materials and Methods: We retrospectively reviewed the medical records of AVF operated in Dong Nai General Hospital (between 09/2017 and 08/2020). Outcomes were compared between two groups: With and without preoperative vascular lập bản đồ to assess the role of this method. Learning curves were analyzed based on the trend of mean operative time and surgical success rate over time, and the number of operations required to overcome the learning curve was calculated with the CUSUM method. &#x0D; Results: The study group consisted of 158 patients, with a mean age of 54.76 ± 26. Male/ female rate was nearly 1:1. Short-term outcomes: Success rate was 87.3%, failure rate was 12.7%, reoperation rate was 7.6%. At 3 months, 6 months, and 9 months follow–up, the AVF patency was 86.70%, 84.18%, and 80.38%, respectively. Vascular lập bản đồ has a better trend of the short-term outcome (83.8% vs. 90.4%; P = 0.231), as well as AVF patency at 3 months, 6 months, 9 months (83.54% vs. 89.87%; P = 0.174), (79.75% vs. 88.61%; P = 0.066) and (75.95% vs. 84.08%; P = 0.077), respectively. However, the difference was not significant. In case of preoperative vascular lập bản đồ, the number of operations required to overcome the learning curve was 75 cases. &#x0D; Conclusion: Arteriovenous fistula surgery at Dong Nai General Hospital has a good short term and mid-term outcome. Preoperative vascular mapping seemed to improve the outcomes.

Comparison of immediate and short-term outcomes of cricoarytenoid and thyroarytenoid lateralization in dogs with idiopathic laryngeal paralysis.

To compare the immediate and short-term outcomes of thyroarytenoid lateralization (TAL) and cricoarytenoid lateralization (CAL) for the treatment of canine laryngeal paralysis in dogs. A prospective, clinical trial. Fourteen client-owned dogs referred to our hospital because of bilateral laryngeal paralysis. Dogs with confirmed laryngeal paralysis were randomly assigned to the CAL or TAL group. Video images of the rima glottidis obtained preoperatively, immediately postoperatively (t0), and 15 days postoperatively (t1) were digitized. The rima glottidis area was measured using image-analysis software. An increase in the rima glottidis area was expressed as a percentage of the preoperative area. The rima glottidis area increased by a mean of 152% at t0 and 127% at t1 for the TAL group and 205% at t0 and 199% at t1 for the CAL group compared with preoperative values. The increase in the rima glottidis area differed (P < .05) between the 2 groups at all postoperative time points. A reduction of the area occurred at t1 in both groups. There was no difference between t0 and t1 (P > .05) in the CAL group but there was a large difference (P < .05) in the TAL group. Cricoarytenoid lateralization and TAL were both effective for surgical abduction of the arytenoid cartilage. Although a reduction (P < .05) in the rima glottidis area occurred in the TAL group at t1, we observed no associated clinical signs. Cricoarytenoid lateralization and TAL result in good short-term outcomes in dogs with laryngeal paralysis.

Analysis of 87 Nephrectomies in a Tertiary Healthcare Center in Nigeria.

Nephrectomy is one of the most frequently performed operations on the kidney. It is necessary for treatment of malignant as well as some benign renal conditions. This was a five-year retrospective review of all adult patients who had open nephrectomy in Lagos University Teaching Hospital, Lagos, Nigeria between January 2014, and December 2019. The cases were traced using clinic, ward, and theatre records. The clinical and operative details of these patients were retrieved and analysed. Clinical information extracted included patients' demography, clinical presentations, diagnosis, procedures performed, complications and the immediate treatment outcome. Data were analysed using SPSS for Mac Version 25.0. Results were displayed in simple proportions using tables and charts. A total of 87 patients' records were available for review. Age range was15-76years with a mean and median age of 49.415 and 52 years, respectively. Majority, 73(83.9%) of the patients presented with at least one symptom, whereas14(17.7%) were asymptomatic. Loin pain was the commonest presentation in 72(82.8%). Indication for nephrectomy were benign in 28(32.2%) and malignant in 59(67.8%) patients. Overall, renal cell carcinoma was the most common indication for nephrectomy accounting for 59.8% of all nephrectomies. A total of thirty-one morbidities occurred in sixteen patients with a complication rate of 18.4% while transfusion rate was 40.2%. Reoperation and mortality rates were 2.3 and 3.4%, respectively. Malignant renal tumors are predominant indications for nephrectomy in our institution. Though associated with a high transfusion rate, open nephrectomy remains a safe procedure with a good short-term outcome.

Midterm results of arteriovenous fistula patency at Dong Nai General Hospital

Background: End-stage renal disease (ESRD) has dramatically increased in number and hemodialysis remains the main therapy. Arteriovenous fistula plays a critical role for dialysis patients. &#x0D; Materials and Methods: We retrospectively reviewed the medical records of AVF operated in Dong Nai General Hospital (between 09/2017 and 08/2020). Outcomes were compared between two groups: With and without preoperative vascular lập bản đồ to assess the role of this method. Learning curves were analyzed based on the trend of mean operative time and surgical success rate over time, and the number of operations required to overcome the learning curve was calculated with the CUSUM method. &#x0D; Results: The study group consisted of 158 patients, with a mean age of 54.76 ± 26. Male/ female rate was nearly 1:1. Short-term outcomes: Success rate was 87.3%, failure rate was 12.7%, reoperation rate was 7.6%. At 3 months, 6 months, and 9 months follow–up, the AVF patency was 86.70%, 84.18%, and 80.38%, respectively. Vascular lập bản đồ has a better trend of the short-term outcome (83.8% vs. 90.4%; P = 0.231), as well as AVF patency at 3 months, 6 months, 9 months (83.54% vs. 89.87%; P = 0.174), (79.75% vs. 88.61%; P = 0.066) and (75.95% vs. 84.08%; P = 0.077), respectively. However, the difference was not significant. In case of preoperative vascular lập bản đồ, the number of operations required to overcome the learning curve was 75 cases. &#x0D; Conclusion: Arteriovenous fistula surgery at Dong Nai General Hospital has a good short term and mid-term outcome. Preoperative vascular mapping seemed to improve the outcomes.

Transcatheter Mitral Valve-in-Valve Implantation With a New Transcatheter Heart Valve for Bioprosthetic Degeneration.

BackgroundTranscatheter mitral valve-in-valve (TMVIV) procedure with aortic transcatheter heart valves has recently become a less invasive alternative for patients with mitral bioprosthetic dysfunction. This study reports the initial experience of TMVIV implantation using the J-Valve System (JieCheng Medical Technology Corporation Ltd., Suzhou, China).MethodsA retrospective observational multicenter study was conducted to evaluate the short-term outcomes of TMVIV. In total, 26 consecutive patients with symptomatic bioprosthetic failure at eight hospitals underwent TMVIV using the J-Valve System between May 2019 and June 2021. Procedural results and clinical outcomes were analyzed using the Mitral Valve Academic Research Consortium criteria.ResultsThe mean age was 75.3 ± 7.1 years and 69.2% of patients were female. The mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 12.3 ± 8.3%. The technical success rate was 96.2%. Nine of the 26 patients (34.6%) were implanted with a J-Valve of a size equal to the internal diameters of the deteriorated prostheses. At the 30-day and 1-year follow-ups, all-cause mortality was 3.8 and 16.0% and the stroke rates were 0 and 12.0%, respectively. Device-related mortality was 0% and the mean mitral valve gradient was 6.4 ± 2.7 mm Hg. No patient experienced device embolization, left ventricular outflow tract obstruction, or mitral valve reintervention. Postprocedural mitral regurgitation was none or trace in all the patients. All the patients were in the New York Heart Association (NYHA) class ≤ II at the last follow-up.Conclusion:Transcatheter implantation of the J-Valve System in high-risk patients with mitral bioprosthetic dysfunction was found to be a reasonable alternative and associated with good short-term outcomes.

Palliative Gastrointestinal Surgery in Patients With Advanced Peritoneal Carcinomatosis: Clinical Experience and Development of a Predictive Model for Surgical Outcomes.

BackgroundPalliative gastrointestinal (GI) surgery potentially relieves distressing symptoms arising from intestinal obstruction (IO) in patients with advanced peritoneal carcinomatosis (PC). As surgery is associated with significant morbidity risks in advanced cancer patients, it is important for surgeons to select patients who can benefit the most from this approach. Hence, we aim to determine predictors of morbidity and mortality after palliative surgery in patients with PC. In addition, we evaluate the utility of the UC Davis Cancer Care nomogram (UCDCCn) and develop a simplified model to predict short-term surgical mortality in these patients.MethodsA retrospective review of patients with IO secondary to PC undergoing palliative GI surgery was performed. Logistic regression was used to determine independent predictors of 30-day morbidity and mortality after surgery. UCDCCn was evaluated using the area under the curve (AUC) for discriminatory power and the Hosmer-Lemeshow test for calibration. Our simplified model was developed using logistic regression and evaluated using cross-validation.ResultsA total of 254 palliative GI surgeries were performed over a 10-year duration. The 30-day morbidity and mortality were 43% (n = 110) and 21% (n = 53), respectively. Preoperative albumin, age, and emergency nature of surgery were significant independent predictors for 30-day morbidity. A simplified model using preoperative Eastern Cooperative Oncology Group (ECOG) status and albumin (AUC = 0.71) achieved better predictive power than UCDCCn (AUC = 0.66) for 30-day mortality.ConclusionGood ECOG status and high preoperative albumin levels were independently associated with good short-term outcomes after palliative GI surgery. Our simplified model may be used to conveniently and efficiently select patients who stand to benefit the most from surgery.

Impact of directional coronary atherectomy followed by drug-coated balloon strategy to avoid the complex stenting for bifurcation lesions.

Although the simple single stenting rather than complex double stenting is recommended on percutaneous coronary intervention (PCI) for bifurcation lesions, double stenting cannot always be avoided. We investigated the impact of directional coronary atherectomy (DCA), followed by drug-coated balloon (DCB) treatment to reduce the number of stents and avoid complex stenting in PCI for bifurcation lesions and short-term patency. DCA treatment without stents was attempted for 27 bifurcation lesions in 25 patients, of those, 26 bifurcation lesions in 24 patients were successfully treated and 3-month follow-up angiography and optical coherence tomography (OCT) were performed. Sixteen lesions (59.3%) were related to left main trunk distal bifurcations, and 7 (25.9%) were true bifurcation lesions. Among the true bifurcation lesions, 4 lesions (57.1%) needed 1 stent, and the other 3 lesions (42.9%) needed no stents. Among the non-true bifurcation lesions, 1 lesion (5.0%) needed bailout stent and other lesions (95.0%) needed no stents. According to DCA followed by DCB treatment, the angiographic mean diameter stenosis improved from 65.5 ± 15.0% to 7.8 ± 9.8%, and the mean plaque area in intravascular ultrasound improved from 80.4 ± 10.5% to 39.0 ± 11.5%, respectively. Angiographic and OCT late lumen loss values were 0.2 ± 0.6mm and 1.4 ± 1.9mm, respectively. No patient had in-hospital major adverse cardiac events (MACE) and 3-month MACE. In conclusion, compared with standard provisional side branch stenting strategy, DCA followed by DCB treatment might reduce the number of stents, avoid complex stenting for major bifurcation lesions and provide good short-term outcomes.