Incidence Of Late Complications Research Articles

Clinical efficacy of preoperative radiotherapy and chemotherapy in 39 patients with locally advanced cervical cancer

Objective To analyze the clinical efficacy of preoperative concurrent radiotherapy and chemotherapy and radical operation in the treatment of cervical cancer patients with locally advanced cervical cancer (IB-IIB). Methods 80 patients who were diagnosed locally advanced (stage IB-IIB) cervical cancer, were divided into observation group (preoperative radiotherapy and chemotherapy group) and control group (radical radiotherapy group). The short-term efficacy, complications and follow-up data were compared between the two groups. Results The short-term efficacy of the observation group was 87.2%, which of the control group was 95.1%, and there was no significant difference (χ2=1.579, P=0.209). As to the early complications of the two groups, there were no significant differences in gastrointestinal tract reaction(χ2=0.000, P=0.987), rectal reaction(χ2=2.709, P=0.100), bladder reaction (χ2=1.343, P=0.247) and bone marrow suppression(χ2=1.898, P=0.168). Late complications: in the observation group, the radiation proctitis[4 cases(10.3%) vs.14 cases(34.1%)]and the radiation cystitis[3 cases(7.7%) vs.13 cases(31.7%)] were less than those of the control group, the differences were statistically significant(χ2=6.542, P=0.011&χ2=7.205, P=0.007). The average follow-up time was 38.6 months in the observation group, which was 44.8 months in the control group.There was no significant difference in survival rate between the two groups(χ2=0.075, P=0.784 & χ2=0.032, P=0.858). Conclusion Locally advanced cervical cancer (IB-IIB) patients received preoperative concurrent radiotherapy and chemotherapy has important clinical value.The treatment makes the local giant block tumor shrink significantly, which is conducive to the implementation of surgery, and reduce the incidence of late complications compared with radical radiotherapy. Key words: Cervical neoplasms; Locally advanced; Radiotherapy; Chemotherapy

Percutaneous Dilatational Tracheostomy via Griggs Technique.

Tracheostomy is considered the airway management of choice for patients who need prolonged mechanical ventilation support. Percutaneous Dilatational Tracheotomy (PDT) is a technique that can be performed easily and rapidly at bedside and is particularly useful in the intensive care setting. The Griggs percutaneous tracheotomy is unique in its utilization of a guide wire dilator forceps. We aimed to describe the early perioperative and late postoperative complications of PDT using the Griggs technique in patients in the intensive care unit (ICU). This cross-sectional study was conducted on all patients who underwent tracheostomy in the ICU of the Imam Reza Hospital of Kermanshah, Iran, from June 2011 to June 2015. PDT was performed in 184 patients with the Griggs technique. Demographic variables, as well as perioperative and late postoperative complications were recorded. The mean age of patients was 57.3 ± 15.37 years. The most common primary causes of tracheostomy were hypoxic brain damage disorders (43.2%) and pneumonia (14.8%). Perioperative and early complications occurred in 16.7 % of procedures, of which 9.3% were bleedings (minor, significant and major). Furthermore, the incidence of late complications was 8.6%, including: stomal infection, difficult replace tracheostomy tube, tracheoesophageal fistula, tracheal stenosis, and tracheomalacia. PDT via Griggs technique is a safe, quick, and effective method. The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure for daily care implemented in the ICU.

The scalp as a donor site for skin grafting in burns: retrospective study on complications

BackgroundSplit skin grafting (SSG) is the cornerstone in the treatment of deep burns and large skin defects. Frequently used donor sites are the thigh, abdomen and buttocks. The scalp is less common while considered as a reliable donor site. Advantages are a large surface area, rapid wound healing, cosmetically favourable results and multiple harvests from the same donor site. Complications include scab formation, chronic folliculitis and alopecia but have been recorded sporadically in previous studies. This article evaluates the complication rate of the scalp donor site in the treatment of deep burns in the Beverwijk Burn Centre.MethodsA retrospective study was performed of all patients who received a skin graft from the scalp at the Beverwijk Burn Centre between January 2004 and December 2012. Data were collected from medical files of included patients, including gender, age, type of burn (scald, flame, other) and total body surface area (TBSA) burned at the time of first surgery. Postoperative variables were healing time of the donor site and incidence of complications. During follow-up, the incidence of late complications was reviewed.ResultsA total number of 105 grafts were analysed in 93 patients: 58 males (62 %) and 35 females (38 %), with a median age of 2 years and 3 months old. Of the patients, 30 (32 %) had flame burns and 57 (61 %) had scald burns. Eighty-seven percent of patients had a TBSA burned of 5 % or less. All donor sites healed within 14 days. No alopecia or scar hypertrophy developed at the donor sites. Two patients (2.2 %) developed folliculitis; one patient (1.1 %) showed scab formation.ConclusionsThe scalp as a donor site in our Burn Centre shows a comparable short-term complication rate to the previous literature, with quick healing and no long-term complications. Therefore, we propose the consideration of the scalp as a primary donor site, especially in young children, where the scalp offers a larger donor site area than the buttocks or thighs.

Suction evacuation of hemothorax: A prospective study.

Although tube thoracostomy is a common procedure after thoracic trauma, incomplete evacuation of fluid places the patient at risk for retained hemothorax. As little as 300 to 500 cm of blood may result in the need for an additional thoracostomy tube or, in more severe cases, lung entrapment and empyema. We hypothesized that suction evacuation of the thoracic cavity before tube placement would decrease the incidence of late complications. Patients requiring tube thoracostomy within 96 hours of admission were prospectively identified and underwent suction evacuation of the pleural space (SEPS) before tube placement. These patients were compared to historical controls without suction evacuation. Demographics, admission vital signs, laboratory values, details of chest tube placement, and outcomes were collected on all patients. Multivariable logistic regression was used to compare outcomes between groups. A total of 199 patients were identified, consisting of 100 retrospective controls and 99 SEPS patients. There were no differences in age, sex, admission injury severity score or chest abbreviated injury score, admission laboratory values or vital signs, or hospital length of stay. Mean (SD) volume of hemothorax in SEPS patients was 220 (297) cm; with only 48% having a volume greater than 100 cm at the time of tube placement. Three patients developed empyema, and 19 demonstrated retained blood; there was no difference between SEPS and control patients. Suction evacuation of the pleural space was significantly protective against recurrent pneumothorax after chest tube removal (odds ratio, 0.332; 95% confidence interval, 0.148-0.745). Preemptive suction evacuation of the thoracic cavity did not have a significant impact on subsequent development of retained hemothorax or empyema. Suction evacuation of the pleural space significantly decreased incidence of recurrent pneumothorax after thoracostomy removal. Although the mechanism is unclear, such a benefit may make this simple procedure worthwhile. A larger sample size is required for validation and to determine if preemptive thoracic evacuation has a clinical benefit. Therapeutic/care management study, level IV.

Within the next five years, adaptive hypofractionation will become the most common form of radiotherapy.

Within the next five years, adaptive hypofractionation will become the most common form of radiotherapy.

Radiotherapy alone or combined with chemotherapy as definitive treatment for squamous cell carcinoma of the tonsil.

This study is aimed at updating our institution's experience with definitive radiotherapy (RT) for squamous cell carcinoma of the tonsil. We reviewed 531 patients treated between 1983 and 2012 with definitive RT for squamous cell carcinoma of the tonsil. Of these, 179 patients were treated with either induction (n=19) or concomitant (n=160) chemotherapy. Planned neck dissection was performed on 217 patients: unilaterally in 199 and bilaterally in 18 patients. Median follow-up was 5.2years for all patients (range 0.1-31.6years) and 8.2years for living patients (range 1.9-31.6years). The 5-year local control rates by T stage were as follows: T1, 94%; T2, 87%; T3 79%; T4, 70%; and overall, 83%. Multivariate analysis revealed that local control was significantly influenced by T stage and neck dissection. The 5-year cause-specific survival rates by overall stage were as follows: I, 94%; II, 88%; III, 87%; IVA, 75%; IVB, 52%; and overall, 78%. Multivariate analysis revealed that cause-specific survival was significantly influenced by T stage, N stage, overall stage, fractionation, neck dissection, sex, and ethnicity. Of 77 patients treated with ipsilateral fields only, contralateral neck failure occurred in 1%. The rate of severe complications was 12%. Definitive RT for patients with tonsillar squamous cell carcinoma provides control rates equivalent to other modalities with a comparatively low incidence of late complications. Patients with anterior tonsillar pillar or tonsillar fossa primaries that are well lateralized with no base of tongue or soft palate extension may be treated with ipsilateral fields.

Endovascular Stenting for Traumatic Common Iliac Pseudoaneurysm as an Adjunct following Exploratory Laparotomy in a Stab Injury Patient

ABSTRACT Traumatic iliac vessel injuries, especially secondary to penetrating wounds, are often associated with a very high mortality rate. The patients usually present to the trauma bay in profound hemorrhagic shock, which, in turn, triggers the vicious cycle of hypothermia, coagulopathy, and acidosis. Iliac artery injuries should be managed promptly because of the high incidence of late complications of pseudoaneurysm and arteriovenous fistulae and risks of subsequent arterial thrombosis and distal ischemia. We report a case of a 17-year-old female who was brought in following a stab wound in the right lower quadrant (RLQ). A postlaparotomy computed tomography (CT) scan performed revealed a pseudoaneurysm on the right common iliac. A pelvic angiography was performed, which was followed by an endovascular placement of a covered stent on the right common iliac artery. We discuss an interesting case along with discussion of relevant literature. How to cite this article Biswas S, Nagarakanti N. Endovascular Stenting for Traumatic Common Iliac Pseudoaneurysm as an Adjunct following Exploratory Laparotomy in a Stab Injury Patient. Panam J Trauma Crit Care Emerg Surg 2016;5(3):172-176.

Laparo- and thoracoscopic aortic aneurysm neck optimization and treatment of potential endoleaks type IA and II in a porcine model.

BackgroundEndovascular repair of aortic aneurysms has a higher incidence of late complications, and open conversion (OC) associated with high mortality may be required. As alternatives to OCs, we propose minimal invasive laparo-/thoracoscopic approaches, either to control endoleaks after endovascular repair, or to convert non-endovascular treatable cases due to a hostile neck anatomy by inserting a peri-aortic PTFE collar before endovascular repair. Such interventions may reduce complications and the necessity for OCs in the future.MethodsIn twelve pigs, were 10 had infra-/juxtrarenal AAAs, externally placed collars/aneuwraps around the proximal AAA neck and just below the left subclavian artery and division of the aortic side branches were carried out laparo-and thoracoscopically.ResultsFor the laparoscopic and thoracoscopic procedures respectively, mean operative time was 143 ± 41 min and 86 ± 51 min and a mean of 2.6 and 2.25 aortic side branches were ligated/divided. For both procedures, the last half in the series were carried out significantly faster (p < 0.05) indicating a learning curve. Blood loss was minimal and no procedure related complications were seen.ConclusionUsing these minimal invasive endoscopic approaches, it seems feasible to externally band aneurysm necks and ligate aortic side branches in a pig model. These procedures could potentially be considered as alternatives to OCs in controlling endoleaks and in improving the safety of endovascular interventions. As endoscopic aortic surgery is challenging a learning curve is expected. Practicing the described procedures using this model, can be used as a learning tool prior to similar interventions on humans.

A retrospective review of the incidence of various complications in different delayed breast reconstruction methods

Background: Breast reconstruction is a common standard procedure in many centres after breast cancer surgery. The aim of the present study was to investigate and compare the incidence of various complications in different reconstruction methods. Method: Six hundred and eighty-five patients were retrospectively classified into five groups: (1) Deep inferior epigastric perforator flap (DIEP), (2) latissimus dorsi flap (LD), (3) lateral thoracodorsal flap (LTDF), (4) expander with secondary implant (EXP), and (5) direct implant (DI). Demographic and perioperative data, the incidence of complications, and follow-up data were collected. Results: There was a significant difference between groups regarding overall early complications (p < 0.001). The DIEP group had the highest incidence of overall complications (50.0%) (p < 0.05). DIEP also had the highest incidence of fat necrosis (18.3%), skin necrosis (22.1%), and incidence of reoperation for complications (26.9%) compared to the other reconstruction methods. In the entire group of patients, the overall incidence of late complications (occurring >30 days after surgery) that needed surgical corrections was 54.7%. The incidence of late complications was 46.2% for DIEP, 66.4% for LD, 74.8% for LTDF, 44.9% for EXP, and 62.9% for DI. The DIEP group had higher incidences of late local complications (fat necrosis, skin necrosis, haematoma, seroma, and wound rupture combined), and scars requiring treatment than the other reconstruction methods. Conclusion: Meticulous registration of incidence of different complications in five different breast reconstruction methods revealed high complication rates with all methods. The differences in incidence of complications were related to the operation method used. Based on these results, careful individual planning of a breast reconstruction is mandatory.

Ipsilateral radiotherapy for squamous cell carcinoma of the tonsil

The purpose of this study is to update our institution's experience with ipsilateral radiation therapy (RT) for squamous cell carcinoma of the tonsillar area. Outcome study of 76 patients treated between 1984 and 2012 with ipsilateral RT for squamous cell carcinoma of the tonsil. Patients had either cT1 (n=41, 54%) or cT2 (n=35, 46%) primaries and cN0 (n=27, 36%), cN1 (n=15, 20%), cN2a (n=8, 11%), or cN2b (n=26, 34%) nodal disease. Of these, 32 (42%) patients underwent a planned neck dissection and 21 (28%) patients received concomitant chemotherapy. Median follow-up for all patients was 7.1years (range 0.1-27.2) and 7.8years (range 2.1-27.2years) for living patients. The 2- and 5-year control and survival rates were as follows: local control, 98.6 and 96.9%; local-regional control 95.8 and 92.6%; cause-specific survival 95.9 and 93.1%; and overall survival, 92.1 and 83.8%. One patient failed in the contralateral, non-radiated neck 3years after primary treatment. Univariate analysis revealed that overall survival was significantly influenced by whether the patient had a primary tumor in the anterior tonsillar pillar versus the tonsillar fossa with the latter performing better. The incidence of severe late complications was 16%. Ipsilateral RT for patients with squamous cell carcinoma of the anterior tonsillar pillar or tonsillar fossa with no base of tongue or soft palate extension is an efficacious treatment that provides excellent control rates with a relatively low incidence of late complications.

Paired observation of californium-252 neutron intraluminal brachytherapy combined with external-beam radiotherapy with and without lead shielding for cervical cancer

Objective To compare the efficacy between californium-252(252Cf)neutron intraluminal brachytherapy combined with external-beam radiotherapy with lead-shielding pelvic parallel opposing field technique and non-lead-shielding four-field box technique for cervical cancer. Methods A total of 52 patients with stage Ⅱa-Ⅲb cervical squamous cell carcinoma who were admitted to our hospital from 2004 to 2007 were enrolled as subjects and paired by clinical stage, age, tumor size, and degree of anemia. The 26 pairs of patients were divided into lead-shielding pelvic parallel opposing field group(lead-shielding group)and non-lead-shielding four-field box group(non-lead-shielding group). For all patients in both groups, 252Cf neutron brachytherapy was added in external-beam radiotherapy. The local control(LC), overall survival(OS), and disease-free survival(DFS)rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The difference in the incidence of late complications was analyzed using the McNemar method. Results There were significant differences in 5-year LC, OS, and DFS rates between the lead-shielding group and the non-lead-shielding group(85% vs. 81%,P=0.014; 89% vs. 73%, P= 0.013; 89% vs. 73%, P= 0.013). There was also significant difference in the incidence of late complications between the lead-shielding group and the non-lead-shielding group(12% vs. 23%, P= 0. 008). Conclusions When intraluminal brachytherapy combined with external-beam radiotherapy is used to treat cervical cancer, the centers of the front and back fields should be shielded by lead, regardless of whether the parallel opposing field technique or the four-field box technique is used. Key words: Cervical neoplasms/radiotherapy; Radiotherapy, external beam radiation; Radiotherapy, 252Cf neutron; Lead shielding

What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors?

After bone tumor resection, reconstruction for limb salvage surgery can be challenging because of the resultant large segmental bony defects. Structural allografts have been used to fill these voids; however, this technique is associated with high complication rates. To circumvent the complications associated with this procedure, massive bony allografts have been supplemented with an intramedullary vascularized free fibula. However, few studies have examined the outcomes using this technique in the pediatric and adolescent populations. The purpose of this study was to examine the revision-free survival using he Capanna technique for limb salvage for pediatric lower limb salvage. We attempted to answer the following questions: (1) What was the overall limb salvage rate along with incidence of reoperation and complications? (2) How did pediatric and adolescent patients functionally perform after this technique? (3) What was the incidence of late complications including infection and fracture? (4) What was the incidence of limb length discrepancy? Eighteen pediatric patients who underwent lower extremity limb salvage with the use of cadaveric allograft and intramedullary free fibular transfer (Capanna technique) were identified. There were nine boys males and nine girls with a mean age of 11years (range, 5-18years) and mean followup of 8years (range, 2-15years), respectively. All patients had at least 2years followup. Three patients have not been seen in followup during the past 5-years; however, all had made it to their 5-year clinical followup. The patients' medical records were reviewed for clinical and functional outcomes as well as postoperative complications. Time to union was recorded through an evaluation of radiographs. Mankin functional outcome and Musculoskeletal Tumor Society (MSTS) rating scale were recorded for each patient. The overall limb salvage rate was 94%. Fourteen patients underwent an additional surgical procedure. Six patients underwent additional procedure(s) to treat a symptomatic nonunion. Seventeen of the patients had a good or excellent Mankin score with a mean MSTS rating of 93% at last followup. Six of the patients underwent a limb length modification procedure. Use of large allografts in conjunction with intramedullary vascularized free fibulas appears to be a reliable method for the reconstruction of large bony tumors of the lower extremity in this population, although we did not directly compare this with allografts alone in our study. The use of locked plates may improve union times. The proportion of patients achieving limb preservation was high and complication rates are acceptable. Level IV, therapeutic study.

Colorectal Cancer Surgery in Extreme Elderly Population

Background: Colorectal cancer surgery in extreme elderly population (380 years) is a growing problem and a subject in question. Experiences and results in this scenario are limited. Methods: Medical records of patients 380 years old hospitalized in General Surgery Department in Vega Baja Hospital between January 1st 2008 and December 31st 2012 were retrospectively reviewed. Patients diagnosed with colorectal cancer (CRC) were selected. Data regarding comorbidities, treatment performed, complications and survival were collected. Results: 95 patients (74 colon, 21 rectum) were identified: median age 83.0 years (80 - 93), 64.2% males. 93.7% of patients were operated on: median hospital and post-operative stay of 11 and 9 days, respectively; curative intention surgery 82.1%. 4.2% of patients were treated with interventionist procedures, and 2.1% of patients in a conservative way. 17.9% and 4.2% of patients came up with early and late complications, respectively. Early and late mortality occurred in 9.5% and 3.2% of patients, respectively. By March 2014, with a median follow up of 43.8 months, median overall survival for colorectal cancer patients was 2.7 years (95%IC, 2.0 - 3.2). Univariaye Cox Regresion analysis revealed the presence of cardiomyopathy (p = 0.024), the presence of chornic kidney disease (p = 0.025), the presence of comorbidities (vs absence) (0.026), the number of comorbidities (0.034), type of admission (p = 0.001), treatment with surgery (p = 0.001) and the incidence of early (p = 0.004) or late complications (p = 0.023) associated to overall survival with statically significance. Multivariate Cox Regression analysis showed number of comorbidities (HR = 1.104; 95%CI: 0.851 - 1.431; p = 0.456), treatment with surgery (HR = 4.928; 95%CI: 1.815 - 13.385; p = 0.002), programmed admission into hospital (HR = 2.316; 95%CI: 1.298 - 4.133; p = 0.004), and the incidence of late complications (HR = 4.629; 95%CI: 1.279 - 16.750; p = 0.020) independently associated with overall survival. Interaction test between number of comorbidities and early complication was performed (HR = 1.453; 95%CI: 0.971 - 2.175; p = 0.070). Conclusions: In our experience surgery for CRC patients may increase overall survival even in an extreme elderly population (380 years). Nevertheless when considering surgery for CRC in this subgroup of patients, factor such as type of admission into hospital and comorbidities should be taken into account in order to optimize treatment results in the effort to individualize CRC management in this growing population.

Abstract 12308: Assessment of Liver Fibrosis Using Magnetic Resonance Elastography in Children Who Undergo the Fontan Procedure and Intracardiac Repair

Background: The incidence of late complications related to the liver such as fibrosis/cirrhosis is increasing in patients who have undergone the Fontan procedure and may contribute to morbidity and mortality. Recently, magnetic resonance elastography (MRE), a novel evaluation technique of liver fibrosis, has been attracting attention. However, few reports have described the use of MRE for evaluating liver fibrosis in children with congenital heart disease (CHD). Methods: Thirty-two children were examined and divided into 4 groups: 12 children with CHD who underwent intracardiac repair (ICR; median age, 13.0 years); 10 with CHD who underwent the Fontan procedure (Fontan; 15.3 years); 8 who were included in the control group (control; 15.8 years); and 2 children with cirrhosis (cirrhosis; 16.3 years). The liver stiffness (LS) was estimated by MRE. LS was measured 3 times consecutively, and the mean value was considered for further analysis. Central venous pressure (CVP) and cardiac index (C.I.) were determined by cardiac catheterization. The levels of cardiac biomarkers (NTproBNP and PIIIP) were determined at the same time. Results: Among the 4 groups, no significant differences were observed in age, C.I., and NTproBNP levels. The PIIIP levels in the cirrhosis group were significantly higher than those in the control, but no significant difference in PIIIP levels was found among the other groups (p &lt; 0.01). LS in the Fontan and cirrhosis group was significantly higher than that in the control group (5.6, 15.3 vs. 2.4 kPa, respectively; Fig. 1). Furthermore, there was a strong correlation between LS and CVP (r = 0.802; Fig. 2). Conclusions: This study showed that LS is a direct function of CVP, which should be considered when assessing the degree of liver fibrosis in children with CHD. In particular, in the case of children who undergo the Fontan procedure, the highly sensitive MRE can be used to evaluate liver fibrosis and help detect LS earlier than cardiac biomarkers do.

Long-term outcome following Thulium VapoEnucleation of the prostate

To evaluate Thulium VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) with long-term follow-up. A prospective analysis of 124 patients who underwent ThuVEP between January 2007 and July 2008 at our institution was done. ThuVEP was carried out using the 70-Watt 2-μm continuous wave Tm:YAG laser. Patient demographic, perioperative complications, and follow-up data were analysed. The median (interquartile range) preoperative prostate volume was 58.5 (45-70.75) cc. The median operation and enucleation time were 74 (60-100) and 32.54 (25.62-37.52) min, respectively. The median catheter time and postoperative hospital stay were 2 (2-2) and 4 (3-5) days, respectively. Nine (7.3 %) patients required a second-look operation in the immediate postoperative course (failed morcellation = 2, clot retention = 3, and residual adenoma = 4). Two patients needed blood transfusions (1.6 %) postoperatively. At 12-month follow-up, International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoiding residual urine (PVR) improved significantly in comparison with preoperative assessment (p < 0.001). A significant decrease of median PSA (4.7 vs. 0.92 μg/l) was seen at one-year follow-up (p < 0.001). At the 48-month follow-up mark, Qmax, PVR, IPSS, and QoL still differed significantly from baseline (p < 0.001). Bladder neck contractures and urethral strictures each developed in 1.6 and 0.8 % of the patients during follow-up. None of the patients were re-treated during follow-up for recurrent prostatic tissue. ThuVEP is a safe, efficacious, and durable procedure for the treatment of BPO. The incidence of late complications with ThuVEP was low.

Effect of endoscopic sphincterotomy on function of sphincter of Oddi and long-term complications

Objective To investigate the effect of EST on function of sphincter of Oddi and on the long-term complications. Methods A total of 68 patients with common bile duct stones were recruited from January 2009 to January 2013 in The First People＇s Hospital of Hangzhou. All patients were under follow-up to observe the incidence of late complications after EST. Oddi sphincter manometry and bile bacterial culture were performed before EST and one year later. Results With the 13-36 months follow-up,the incidence of late complications was 16.9% （11/65）. The peak pressure and frequency of contraction of Oddi sphincter after EST were significantly lower than those before EST, but there were no significant differences between patients with complication and without （ P 〉 0. 05 ）. After EST, positive rate of biliary bacteria in patients with complications was much higher than that in patients without complications [70% （7/10）vs. 31.7% （13/41）, P = 0. 026], although there were no significant differences between them before EST [54. 5% （6/11 ） vs. 46. 3% （25/54） , P = 0. 618 ）. Logistic regression analysis showed that cholecystolithiasis, bile duct diameter （ 〉 1.5 cm）, number of stone （ 〉 3 ）, maximun diameter of stone （ 〉 20 mm）, large EST were independent risk factors for late complications of EST. Conclusion Importance should be attached to the late complications of EST with Oddi sphincter function declination, and biliary enteric reflux being the basic factor in late compilations after EST, which are also influenced by many risk factors. Key words: Sphincterotomy, endoscopic ; Sphincter of Oddi ; Manometry; Late complications

2183 LONG-TERM OUTCOME FOLLOWING THULIUM VAPOENUCLEATION OF THE PROSTATE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (III)1 Apr 20132183 LONG-TERM OUTCOME FOLLOWING THULIUM VAPOENUCLEATION OF THE PROSTATE Christopher Netsch, Alexander Engbert, Thorsten Bach, and Andreas Gross Christopher NetschChristopher Netsch Hamburg, Germany More articles by this author , Alexander EngbertAlexander Engbert Hamburg, Germany More articles by this author , Thorsten BachThorsten Bach Hamburg, Germany More articles by this author , and Andreas GrossAndreas Gross Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2092AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A prospective study to assess the safety, efficacy, and long-term durability of Thulium VapoEnucleation of the prostate (ThuVEP) for the treatment of symptomatic benign prostatic obstruction (BPO). METHODS One-hundred twenty-four patients underwent ThuVEP between January 2007 and July 2008 at our institution. Patient demographics, perioperative complications, and long-term follow-up data were analyzed. RESULTS Mean age was 70.62±7.95 yrs. Mean prostate volume was 62.3±26.56 cc. Mean operation time was 80.72±28.78 and the enucleation time 32.83±10.04 min, whilst resected tissue weighted 32.97±22.22 gm. Mean catheter time and hospital stay was 2.12±0.87 and 5.5±2.25 days, respectively. Nine (7.3%) patients required a second-look operation in the immediate postoperative course (failed morcellation n=2, clot retention n=3, residual tissue at the apex of the prostate n=4). Two patients needed blood transfusions (1.6%) postoperatively. At 12-month follow-up, international prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual urine (PVR), and prostate-specific antigen (PSA) improved significantly in comparison to preoperative assessment (p<0.001) and continued to do so during subsequent follow-up. At 48-month follow-up, mean Qmax (8.9 vs. 22 ml/s), PVR (126.43 vs. 47.6 ml), IPSS (18.67 vs. 4.8) and QoL (4 vs. 1.33) improved significantly compared with baseline (p<0.001). Bladder-neck contractures and urethral strictures each developed in 1.6% and 0.8% of the patients. None of the patients were re-treated during follow-up for recurrent prostatic tissue. CONCLUSIONS ThuVEP is a safe, efficacious, and durable procedure for the treatment of symptomatic BPO. The incidence of late complications with ThuVEP was very low. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e895 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Netsch Hamburg, Germany More articles by this author Alexander Engbert Hamburg, Germany More articles by this author Thorsten Bach Hamburg, Germany More articles by this author Andreas Gross Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Résultats comparés des bypass gastriques de première et de deuxième intention

In case of failure of bariatric surgery there are indications of revisional surgery, typically Roux-en-Y gastric bypass. Its feasibility as a revision procedure has been demonstrated, but results in terms of excess weight loss are still discussed.A total of 192 consecutive patients who underwent gastric bypass between 2008 and 2012 were retrospectively reviewed. Gastric bypass as primary procedure was performed in 128 patients (BPG1) and as revisional procedure in 64 patients (BPG2). Postoperative data and excess weight loss were compared between the two groups.Preoperative differences between the two groups were in the age, significantly lower in BPG1 (38.1 vs 43.5 years, p = 0.004), preoperative BMI higher in BPG1 as in prevalence of OSAS (18 vs 5%, p = 0.012) and dyslipidemia (27 vs 11%, p = 0.014). Postoperative mortality was nil and 30 days-morbidity comparable (BPG1 vs BPG2: 4.4 vs 4.7%, p=0.57). After a median follow-up of 18 months, incidence of late complications was comparable excepted for wound complications higher after BPG2 (30% vs 10%, respectively, p = 0.015). Excess weight loss was significantly greater after BPG1 (68.5% vs 55.3%, p = 0.0002). Similarly, success rate of surgery, defined by Reinhold criterias, was significantly higher in BPG1 (81% vs 64%, respectively, p = 0.023). In multivariate analysis, BMI> 50 kg/m2 (p = 0.031, RR = 4.56, 95% CI [1.149 to 18.115]) and revisional surgery (p = 0.01, RR = 3.07, 95% CI [1.309 to 7.2]) were significantly associated with risk of failure of surgical treatment.Gastric bypass as revisional surgery after restrictive bariatric surgery is safe and feasible without major increase in morbidity and mortality except for wound complications. Excess weight loss is lower in revisional surgery. A strict selection should be made among patients after failure of a first procedure, particularly in case of super-obesity.

Metabolite Profiling Reveals Normal Metabolic Control in Carriers of Mutations in the Glucokinase Gene (MODY2)

Mutations in the gene encoding glucokinase (GCK) cause a mild hereditary form of diabetes termed maturity-onset diabetes of the young (MODY)2 or GCK-MODY. The disease does not progress over time, and diabetes complications rarely develop. It has therefore been suggested that GCK-MODY represents a metabolically compensated condition, but experimental support for this notion is lacking. Here, we profiled metabolites in serum from patients with MODY1 (HNF4A), MODY2 (GCK), MODY3 (HNF1A), and type 2 diabetes and from healthy individuals to characterize metabolic perturbations caused by specific mutations. Analysis of four GCK-MODY patients revealed a metabolite pattern similar to that of healthy individuals, while other forms of diabetes differed markedly in their metabolite profiles. Furthermore, despite elevated glucose concentrations, carriers of GCK mutations showed lower levels of free fatty acids and triglycerides than healthy control subjects. The metabolite profiling was confirmed by enzymatic assays and replicated in a cohort of 11 GCK-MODY patients. Elevated levels of fatty acids are known to associate with β-cell dysfunction, insulin resistance, and increased incidence of late complications. Our results show that GCK-MODY represents a metabolically normal condition, which may contribute to the lack of late complications and the nonprogressive nature of the disease.

Bilateral biliary drainage for malignant hilar obstruction using the ‘stent-in-stent’ method with a Y-stent

The usefulness of bilateral stent placement for malignant hilar obstruction is still under debate. Nevertheless, many endoscopists advocate the placement of an endoscopic bilateral metal stent using various new devices and techniques. We compared the technical and clinical efficacy, and the short-term and long-term complications of the 'stent-in-stent' method using a Y-stent for malignant hilar obstruction between the early and the late period of this study. Ninety-seven patients treated with Y-stent implantation for malignant hilar obstruction were enrolled retrospectively. In 31 patients treated during the early period, bilateral Y-configured metal stents were placed for malignant hilar obstruction using the older designed Y-stent and a closed-cell second stent. The newly designed Y-stent and a slimmer open-cell second stent were introduced in 66 patients treated during the late period. New techniques learned through experience were gradually applied throughout the entire study period. The rate of successful placement of bilateral stents was significantly higher in patients treated during the late period than those treated during the early period (58.1 vs. 87%; P=0.001). The functional success rate was 97.3%, with no difference between the early and the late periods. Cholangitis occurred as an early complication more frequently during the early period than during the late period (16.1 vs. 1.5%; P=0.012). Cholecystitis as a late complication occurred in 21 of 76 patients (27.6%). The incidence of late complications was similar between the early and the late periods. With the development of new devices and increased technical experience, there were better outcomes during the late period compared with the early period. Endoscopic bilateral metal stenting using a Y-stent is an attractive option for the palliative treatment of malignant hilar obstruction.