Occurrence Of Serious Complications Research Articles

Minimally-invasive tracheostomy (MIT): A care bundle for safety improvement in high-risk critically ill patients

BackgroundDetailed reports are scarce on minimally-invasive tracheostomy (MIT) techniques for critically ill patients with challenging anatomy or complex coagulopathies. In such high-risk patients, conventional percutaneous dilatational tracheostomy (PDT) may lead to severe complications. MethodsAiming to broaden the scope of MIT for patients previously excluded due to high risks, we developed a new care bundle (MIT technique), specifically designed for intensive care specialists. Our study examined the outcomes of MIT in 32 high-risk patients treated in an ICU of a University Hospital with specific focus on gastrointestinal and liver diseases. ResultsWe have modified the conventional PDT technique by incorporating an initial skin incision, blunt dissection, diaphanoscopy-guided probe puncture, and continuous bronchoscopic monitoring. Our care bundle also introduces an anterolateral approach for tracheal entry, a significant advancement for patients with complex neck anatomy or dense vasculature, where an anterolateral trajectory avoids midline blood vessels. This enhanced method has proven to be safer than traditional PDT, with a notable absence of post-procedural hemorrhages, cannula misplacements, or infections. ConclusionThe use of our refined care bundle enabled swift minimally-invasive tracheostomy in high-risk patients without the occurrence of serious complications.

Research progress of pelvic acetabular fractures combined venous thromboembolic disease

Pelvic acetabular fractures(PAFs) are one of the most common types of pelvic fractures, mostly high-energy injuries, with complex pelvic acetabular structure and limited surgical methods. The trauma of the acetabular fracture itself and the need for long-term bed rest after surgery cause particularly complicated clinical complications. Venous thromboembolism (VTE) is one of its high incidence and serious complications. This review mainly focuses on VTE after PAFs, and describes the epidemiology, risk factors and prevention measures of VTE, aiming to help improve the prognosis and avoid the occurrence of serious complications.

Comparison of the first and sixth waves of the SARS-COV-2 coronavirus pandemic in patients with immune-mediated disease.

Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination.Objective To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves.Method Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022.Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts.Results In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine.Conclusion Early detection and vaccination have prevented the occurrence of serious complications.

POSTOPERATIVE NAUSEA AND VOMITING: RETROSPECTIVE COMPARATIVE STATISTICAL STUDY

Postoperative nausea and vomiting (PONV) is a relatively frequent side effect during the first 24 hours following surgery and a major source of discomfort for patients. These are transient symptoms, which can worsen the functional prognosis, but also vital following the occurrence of serious complications. Our objective was to determine the real incidence of PONV in patients operated in our facility, to analyze the different risk factors found in the literature and to evaluate the relevance of our preventive and therapeutic strategies in this matter. We included 92 patients operated from September 23, 2021 to December 09, 2021 in a prospective observational study conducted in the different surgical departments (gynecology, visceral surgery, ear nose and throat department , traumatology) at the Mohamed V provincial hospital of Sefrou. The overall incidence of PONV was 47%. It was 23% at 6 hours and 24% at 24 hours. The incidence of nausea, vomiting, and nausea and vomiting was 17%, 11%, and 19%, respectively. Risk factors associated with the occurrence of PONV were : age (p=0.049), duration of surgery (p<0.01) and type of anesthesia (p=0.043). A preventive strategy with metoclopramide 10mg injectable at induction was followed in only 18% of cases, but was not effective on the occurrence of PONV. Indeed, it was noted that our practitioners had little interest or awareness of an appropriate preventive and curative protocol or strategy. We recommend the development of an antiemetic prophylaxis and the use of a preventive and therapeutic protocol for postoperative nausea and vomiting. For this, our work proposed at the end a practical brochure adapted to our context and which would be applicable in any national hospital structure.

Progress in clinical research on potential therapeutic drugs for acute-on-chronic liver failure

Acute-on-chronic liver failure (ACLF), has a high mortality rate and a poor prognosis. Currently, the only effective treatment for ACLF is liver transplantation. However, the number of patients who can successfully undergo liver transplantation is limited due to the rapid progression of ACLF, the occurrence of serious complications, and a dearth of liver donors. The available drug treatment indication expansion and pathogenesis exploration are expected to delay the progression of ACLF, reduce complications, and provide patients with opportunities for liver transplantation by improving portal vein pressure, inhibiting excessive inflammatory response, correcting energy metabolism disorders, reducing oxidative stress, resisting hepatic cell apoptosis, and promoting liver regeneration.

Ultrasound-guided nerve hydrodissection of cervical nerve roots for cervical radicular pain in patients with mild and moderate to severe stenosis: a retrospective cohort study

Because fascial entrapment neuropathy can occur in multiple locations, ultrasound-guided nerve hydrodissection has become a key component of the treatment of cervical radicular pain. In this paper, we propose a combination of injectates used for nerve hydrodissection of the cervical nerve roots and compare the clinical outcomes of this treatment among patients with different severities of stenosis. This is a retrospective cohort study designed to compare outcomes between patients with mild stenosis and moderate to severe stenosis. Forty-four patients with mild cervical stenosis and 30 patients with moderate to severe cervical stenosis were consecutively enrolled into two groups. A 10-mL mixture in a single level consisting of 5% in Dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve roots hydrodissection. The two groups were compared with regard to their numeric rating scales (NRS) of pain, proportion of patients who exhibited a favorable outcome (a reduction of pain ≥ 50%), duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects. The follow-up period ranged from 3 to 20 months. The NRS of both groups improved significantly by 1 week, 1 month, 3 months, and final follow-up after the initial injection. Differences in the groups’ NRS, proportion of patients who exhibited a favorable outcome, duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects were nonsignificant. There were 4 patients (5.4%) experienced dizziness in that resolved without further treatment. Ultrasound-guided nerve hydrodissection of cervical nerve roots is a safe procedure that reduces pain associated with cervical radicular pain, even in patients with moderate to severe stenosis.

Comparison of the first and sixth waves of the SARS-COV-2 coronavirus pandemic in patients with immune-mediated disease

IntroductionRecent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination. ObjectiveTo compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves. MethodProspective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022.Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts. ResultsIn total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine. ConclusionEarly detection and vaccination have prevented the occurrence of serious complications.

MP58-03 THE USEFULNESS OF THE RESECTION PROCESS MAP FOR ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR RENAL TUMORS: PROPENSITY SCORE MATCHING

You have accessJournal of UrologyCME1 Apr 2023MP58-03 THE USEFULNESS OF THE RESECTION PROCESS MAP FOR ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR RENAL TUMORS: PROPENSITY SCORE MATCHING Atsushi Okada, Kazuya Ohashi, Hiroya Hashimoto, Yuya Ota, Teruaki Sugino, Shoichiro Iwatsuki, Toshiki Etani, Kazumi Taguchi, Taku Naiki, Shuzo Hamamoto, Ryosuke Ando, Noriyasu Kawai, Keiichi Tozawa, and Takahiro Yasui Atsushi OkadaAtsushi Okada More articles by this author , Kazuya OhashiKazuya Ohashi More articles by this author , Hiroya HashimotoHiroya Hashimoto More articles by this author , Yuya OtaYuya Ota More articles by this author , Teruaki SuginoTeruaki Sugino More articles by this author , Shoichiro IwatsukiShoichiro Iwatsuki More articles by this author , Toshiki EtaniToshiki Etani More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Taku NaikiTaku Naiki More articles by this author , Shuzo HamamotoShuzo Hamamoto More articles by this author , Ryosuke AndoRyosuke Ando More articles by this author , Noriyasu KawaiNoriyasu Kawai More articles by this author , Keiichi TozawaKeiichi Tozawa More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Aim of this study was to examine the effect of preoperative 3DCT-based tumor resection simulation, Resection Process Map (RPM) on the outcome and complications of Robot-Assisted Partial Nephrectomy (RAPN). METHODS: We retrospectively analyzed 180 patients aged 20 years or older (RPM group; n=100 and non-RPM group; n=80) who underwent RAPN for renal tumors between November 2012 and February 2022. DICOM files of contrast-enhanced CT images were loaded into the medical imaging workstation Ziostation® 2 to construct an RPM. Based on the 3D structure of the arrangement and shape of the vessels and collecting system exposed on the resected surface by removing the “tumor section with a 5 mm-thick renal parenchymal resection margin” on 3D-CT. Outcome analyzes were performed on cases selected by propensity score matching. The primary endpoint was the achievement rate of trifecta ((1) negative resection margins, (2) warm ischemic time (WIT) within 25 minutes, and (3) no perioperative complications), and the Secondary endpoints were intraoperative and postoperative factors (renal function, intraoperative information, surgery-related time, blood loss, pathology, length of hospital stay, and complications). Summary statistics were calculated with and without RPM and compared using Wilcoxon's rank sum test for metric and ordinal data and Fisher's exact probability for nominal scale data. RESULTS: As a result of propensity score matching, 108 cases (RPM; n=54, non-RPM; n=54) were extracted after adjustment for patient and tumor characteristics, experience of operators and assistants, etc. The achievement rate of trifecta as the primary endpoint showed significantly higher in the RPM group (72.2%) than in the non-RPM group (51.9%) (p=0.047) The results of the secondary endpoints showed that the RPM group had fewer complications of Grade III or higher (RPM 1.9% vs non-RPM 18.5%, p=0.008) and shorter postoperative hospital stay (RPM 7.0 days vs non-RPM 8.0 days, p=0.020). CONCLUSIONS: It was suggested that RPM in preoperative 3D-CT of RAPN may not only contribute to the achievement of trifecta but also suppress the occurrence of serious complications by giving the operator detailed information on tumor resection. Source of Funding: Japanese Society of Endourology Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e795 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Atsushi Okada More articles by this author Kazuya Ohashi More articles by this author Hiroya Hashimoto More articles by this author Yuya Ota More articles by this author Teruaki Sugino More articles by this author Shoichiro Iwatsuki More articles by this author Toshiki Etani More articles by this author Kazumi Taguchi More articles by this author Taku Naiki More articles by this author Shuzo Hamamoto More articles by this author Ryosuke Ando More articles by this author Noriyasu Kawai More articles by this author Keiichi Tozawa More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement PDF downloadLoading ...

Adams-Oliver Syndrome: About A Case

Adams-Oliver syndrome is a polymalformative disease rare whose incidence is estimated at 1/225,000. This is a female newborn, referred by the maternity ward on D0 of life, hospitalized for a polymalformative syndrome. We noted a shallow and non-traumatic parietal ulceration on a background of congenital aplasia of the scalp without bone defect, with peripheral venous ectasia, Cutis Marmorata, Congenital Telangiectatica. Moreover; second and third toe brachydactyly with nail agenesis. We managed the ulcerations with local care and offered regular follow-up to minimize the occurrence of serious complications. Unfortunately the newborn is lost to sight after a few days.

Corneal Crosslinking With Riboflavin and UVA Light in Progressive Keratoconus: Fifteen-Year Results

To analyze the 15-year results of corneal crosslinking (CXL) in progressive keratoconus. Retrospective follow-up analysis of interventional study patients. This study included keratoconic eyes with progressive disease treated from 2001 to 2006 at the Department of Ophthalmology, Carl Gustav Carus University Hospital, TU Dresden, Germany. CXL was performed by applying riboflavin and ultraviolet A (UVA) light according to a standard protocol. The best-corrected distance visual acuity (BCVA), slitlamp examination, and corneal topography as well as corneal thickness values were recorded preoperatively and 15 years after the treatment. A total of 42 eyes received a complete follow-up of 15 years. The mean age of the patients at baseline was 26.9 (95% CI: 25.0-28.8) years. The maximum keratometry was 61.6 (95% CI: 58.2 - 64.9) diopters (D) preoperatively and 55.1 (95% CI: 51.6-58.4) D postoperatively; the decrease was statistically significant (P < .001). The mean keratometry value changed from 50.3 (95% CI: 48.3-52.4) D to 47.5 (95% CI: 45.3-49.4) D (P < 0.001). Furthermore, the thinnest corneal thickness decreased statistically significantly by 40 (95% CI: 24-56) µm (P < .001). The BCVA improved statistically significantly from 0.4 to 0.2 logMAR after the treatment. Retreatment was needed in 14% of cases. Mild scarring of the superficial stromal corneal layers was observed in 36% of the eyes, and in 67% of them visual acuity was stable or even improved. The CXL procedure proved to be an effective method in the treatment of keratoconic eyes in the progressive stage of the disease, and achieved long-term stabilization without the occurrence of serious complications or side effects.

Коронавірусна інфекція: інформативність та своєчасність алгоритму лабораторної діагностики у спортсменів

The purpose of the study was to form a step-by-step algorithm for diagnosing the disease caused by the SARS-CoV-2 virus, taking into account the specifics of athletes’ training. Materials and methods. Such methods as analysis and generalization of data from modern scientific and scientific-methodological literature, including the results of PubMed and MedLine databases were used in the study. Results and discussion. For people who are regularly engaged in physical activity, the disease of COVID-19 has become one of the factors of heart damage in the post-covid period, which often serves as a reason for removing athletes from the training and competition process. Due to their high mobility, contact with a large number of sportsmen during training meetings and competitions, athletes are definitely in the risk group for the disease of COVID-19. Methodologically, laboratory approaches for determining the presence of COVID-19 are divided into general and specific. The latter include an express test for the coronavirus antigen, which in 15 minutes makes it possible to determine the presence of the nucleocapsid protein of the SARS-CoV-2 virus in the human body. This is important for testing athletes before training sessions and competitions, when there is an increased risk of infection, as well as for fulfilling the conditions for athletes to travel abroad. Express tests also include tests using immunochromatographic analysis to establish two classes of antibodies − M and G, detection of RNA 2019 nCoV by the polymerase chain reaction method, tests that are based on enzyme immunoassay. To determine the content of immunoglobulins, it is important to adhere to the timing of the analysis. Diagnostics by the polymerase chain reaction method allows you to directly determine the presence of the virus in the conditions of a specialized laboratory, but not earlier than the third day after infection. Immunoenzymatic (immunofluorescent) diagnostics using ELISA-kits makes it possible to detect in the blood antibodies to the coronavirus, produced by the body in the acute stage of the disease (IgM antibody analysis), i.e. 5–7 days after contact with the virus ("early phase" antibodies infections). Content limits serve as criteria for the informativeness of the test on IgM concentration: &lt;0.9 U∙ml-1 − negative; 0.9−1.0 U ml-1 − indefinite; &gt;1.1 U∙ml-1 − positive. A quantitative test for IgG (immunoglobulin G) antibodies to the spike S-protein of the coronavirus allows to assess the level of neutralizing antibodies to the SARS-CoV-2 coronavirus as a result of the transferred coronavirus disease COVID-19 and / or after vaccination against COVID-19. This analysis should be carried out from the 14th day after the onset of the disease or the administration of the first dose of the vaccine. Conclusion. Thus, by timely and comprehensively applying evidence-based technologies for testing and monitoring the course of the COVID-19 disease, supplementing this algorithm with careful monitoring of the functional state of the cardiovascular system, it is possible to prevent the occurrence of serious complications that can lead to the exclusion of athletes from the training process

Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis

ObjectiveIncomplete Kawasaki disease (IKD) initially presenting as retropharyngeal abnormality is very rare and is prone to misdiagnosis and missed diagnosis, often leading to poor prognosis. Most patients were misdiagnosed with retropharyngeal abscesses. Here, we describe and compare IKD patients initially presenting with retropharyngeal abnormalities, typical KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients.MethodsWe performed a retrospective case–control study comparing IKD patients initially presenting with retropharyngeal abnormalities to both KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients admitted to Shenzhen Children’s Hospital between January 2016 and December 2021.ResultsWe evaluated data from 10 IKD patients initially presenting with retropharyngeal abnormalities (Group A), 20 typical KD patients (Group B) and 16 surgical drainage confirmed retropharyngeal abscess patients (Group C). Compared to Group B, we observed that Group A was older and had a more intense inflammatory response. On the day of admission, Groups A and C had similar early clinical presentations, and there were no significant differences in any major signs or symptoms. Close observation for the development of new KD signs and symptoms and unresponsiveness to empirical antibiotic therapy after 3 days is extremely important. The CRP (p = 0.011), AST (p = 0.002) and ALT (p = 0.013) levels were significantly higher and the WBC (P = 0.040) levels were significantly lower in Group A than in Group C. Neck radiological findings, such as the presence of ring enhancement (p = 0.001) and mass effects on the airway, are also useful tools for distinguishing these two diseases.ConclusionThe careful observation of the signs and symptoms of this disease and the comprehensive analysis of the laboratory tests and neck radiological findings may help clinicians become aware of retropharyngeal abnormality as an atypical presentation of KD. Then, unnecessary treatments could be reduced, and the occurrence of serious complications can be avoided.

Machine learning model-based risk prediction of severe complications after off-pump coronary artery bypass grafting.

Compared with coronary artery bypass grafting (CABG) under cardiopulmonary bypass, off-pump coronary artery bypass (OPCAB) is minimally invasive and reduces the risk of intraoperative blood transfusion and acute kidney injury. Nonetheless, OPCAB-related complications still pose a threat. Machine learning technology can analyze a large number of clinical data, establish risk prediction models and help clinicians make early and correct clinical decisions. Risk prediction models are available for mortality and morbidity after cardiac surgery, but they are not specific to OPCAB. This study aimed to develop a predictive model of severe complications after OPCAB, based on machine learning. Anesthesia records of OPCAB from the General Hospital of the Northern Theater Command (Shenyang, China) collected between January 1, 2019, and June 15, 2020, were analyzed. The endpoint of the study was the occurrence of serious complications after OPCAB (postoperative unplanned intra-aortic balloon pump, secondary surgery and death). The features entered into the models were as follows: intraoperative ventricular fibrillation, number of saphenous vein grafts, nerve block (NeB), venous oxygen saturation (SvO2), skin incision-bypass time, and hypertension. A total of 8 machine learning algorithms were tested: logistic regression analysis (LRA), k-nearest neighbor (KNN), naïve Bayes (NB), support vector machine (SVM), random forest (RF), extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and categorical features gradient boosting (CatBoost). Among the 506 patients found in the records, 27 met the endpoint. The highest area under the curve (AUC) value was achieved with the XGBoost model (AUC = 0.94), and the lowest with the SVM model (AUC = 0.75). The highest and lowest accuracy were observed with the XGBoost and NB models, respectively, while the highest and lowest precision were achieved using the SVM and NB models, respectively. Based on the receiver operating characteristic (ROC) curves, the XGBoost model was selected as the most useful in this study. This study suggests using the XGBoost model to predict the risk of complications after OPCAB.

The development and validation of a predictive model for neonatal phototherapy outcome using admission indicators.

Delayed exchange transfusion therapy (ETT) after phototherapy failure for newborns with severe hyperbilirubinemia could lead to serious complications such as bilirubin encephalopathy (BE). In this current manuscript we developed and validated a model using admission data for early prediction of phototherapy failure. We retrospectively examined the medical records of 292 newborns with severe hyperbilirubinemia as the training cohort and another 52 neonates as the validation cohort. Logistic regression modeling was employed to create a predictive model with seven significant admission indicators, i.e., age, past medical history, presence of hemolysis, hemoglobin, neutrophil proportion, albumin (ALB), and total serum bilirubin (TSB). To validate the model, two other models with conventional indicators were created, one incorporating the admission indicators and phototherapy failure outcome and the other using TSB decrease after phototherapy failure as a variable and phototherapy outcome as an outcome indicator. The area under the curve (AUC) of the predictive model was 0.958 [95% confidence interval (CI): 0.924–0.993] and 0.961 (95% CI: 0.914–1.000) in the training and validation cohorts, respectively. Compared with the conventional models, the new model had better predictive power and greater value for clinical decision-making by providing a possibly earlier and more accurate prediction of phototherapy failure. More rapid clinical decision-making and interventions may potentially minimize occurrence of serious complications of severe neonatal hyperbilirubinemia.

Clinical analysis of bronchoscope diagnosis and treatment for airway foreign body removal in pediatric patients

BackgroundAlong with the wide spread application and technical development of the flexible and rigid bronchoscopy, the airway foreign body removing method cme to the specific technique for different foreign bodies from the single foreign body forceps.MethodsSelected 633 children who were diagnosed as airway foreign bodies by the Department of Respiratory Intervention, Children's Hospital affiliated to Shandong University from January 1st, 2018 to December 31st, 2021, and the airway foreign bodies were diagnosed using bronchoscopy. After comprehensive assessment of the foreign body nature in the airway, the foreign bodies were removed by freezing, laser, electrocoagulation, balloon and other techniques, the success rate of the foreign body removed from the airway was observed, the percentage of the foreign body removed using different techniques, the operation time, and the incidence of post-adverse reactions during operation.ResultsThe success rate using flexible bronchoscope alone to remove foreign bodies in the airway was 99.2%. After flexible bronchoscopy, 19 cases of foreign bodies were removed by vacuum suction alone, 513 cases were removed by foreign body forceps alone, 62 cases were combined with cryotherapy, 2 cases were electrocoagulation, 6 cases were mesh baskets, 3 cases were balloons, 5 cases were laser, and various 18 cases of foreign bodies were invloved by technical combination. 5 cases of flexible bronchoscope combined with rigid bronchoscope combined to remove foreign bodies. The operation time was from 5 min to 1 h, with an average of 20 min. There were 17 cases of hypoxemia (2.7%) during operation, 36 cases (5.7%) of bleeding caused by airway mucosa injury after treatment, and 70 cases (11.2%) of laryngeal edema. The total incidence of adverse reactions was 19.6%, there were no deaths due to foreign bodies and treatment.ConclusionsAccording to different properties of airway foreign bodies, it is safe and effective to select appropriate techniques to remove foreign bodies using the flexible bronchoscope, which can increase the removal rate of airway foreign bodies and reduce the occurrence of serious complications.

Comparison of Endoscopic Dilatation and Heller's Myotomy for Treating Esophageal Achalasia in Children: A Multicenter Study

To compare the efficacy of, and complications from, the 2 main treatments for achalasia: endoscopic dilatation and surgical cardiomyotomy (Heller's myotomy). We retrospectively collected data on children treated for achalasia over an 11-year period from 8 tertiary pediatric centers. A line of treatment was defined as performing either Heller's myotomy or 1-3 sessions of endoscopy dilatation over 3months. Treatment success was a priori defined as clinical improvement and no need for new treatment. Ninety-seven children (median age, 12years; 57% boys) were included. The median time to diagnosis was 10.5months, and the median follow-up period was 27months. Thirty-seven children were treated by Heller's myotomy and 60 by endoscopy dilatation as the first-line treatment. After adjustment for potentially confounding factors, Heller's myotomy was significantly more successful than endoscopy dilatation (hazard ratio, 3.93 [1.74; 8.88]; P=.001), with a median survival without failure of 49 and 7months, respectively, and with no significant difference in the occurrence of complications (35.2% for Heller's myotomy, 29.7% for endoscopy dilatation, P=.56). Hydrostatic dilatation was as successful as pneumatic dilatation (hazard ratio, 1.35 [0.56; 3.23]; P=.50). Heller's myotomy is more successful than endoscopy dilatation, with no significant difference in the occurrence of serious complications. This raises the potential role of peroral endoscopic myotomy as an alternative treatment to Heller's myotomy.

What Factors Are Associated With Poor Shoulder Function and Serious Complications After Internal Fixation of Three-part and Four-part Proximal Humerus Fracture-dislocations?

What Factors Are Associated With Poor Shoulder Function and Serious Complications After Internal Fixation of Three-part and Four-part Proximal Humerus Fracture-dislocations?

Micropulse vs. continuous wave transscleral cyclophotocoagulation in neovascular glaucoma.

Neovascular glaucoma (NVG) is a refractory form of glaucoma, associated with important morbidity, for which no consensus exists regarding the optimal choice of therapy. The primary aim of our study was to compare the performances of micropulse transscleral cyclophotocoagulation (MP-TSCPC) and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) in the treatment of neovascular glaucoma (NVG). A total of 24 eyes for MP-TSCPC and 22 eyes for CW-TSCPC, all with NVG were included. The procedures were performed using either the Iridex Cyclo G6 (IRIDEX Laser System), the MP3, or the G-Probe devices. Intraocular pressure (IOP), visual acuity (VA), the mean number of antiglaucoma medications, and postoperative complications were monitored. The minimum follow-up was 12 months. The success rate at 12 months was 54.5% in the CW-TSCPC group and 33.3% in the MP-TSCPC group. The mean IOP at baseline was 35.82 mm Hg for CW-TSCPC and 34.71 mm Hg for MP-TSCPC. The change from baseline in IOP at 12 months was 11.95 mm Hg in the CW-TSCPC group and -8.04 mm Hg in the MP-TSCPC group. There was a significant difference in the occurrence of serious complications (worsening of VA, hypotony, and phthisis bulbi) between the two methods, with CW-TSCPC associated with more important adverse effects (P=0.045). There was a decrease in the number of topical antiglaucoma medications in both groups: in the MP-TSCPC group from a mean number of 2.6 at baseline, to 1.7 at 3 months, followed by a slight increase to 2.1 at 12 months and in the CW-TSCPC group from 2.8 at baseline, to 1.4 at 3 months and 1.9 at 12 months. Our study concluded that both MP-TSCPC and CW-TSCPC could manage NVG, but, while CW-TSCPC revealed higher IOP control in the long term (which did not reach statistical significance), it also had a significantly lower safety profile.

Decline in serum albumin concentration is a predictor of serious events in nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome, which includes diabetes mellitus and hyperlipidemia. A fraction of NAFLD patients develop nonalcoholic steatohepatitis, leading to cirrhosis associated with various serious complications, including hepatocellular carcinoma, gastroesophageal varices, cardiovascular events, and other organ malignancy. Although the incidence of chronic viral hepatitis with associated complications has gradually decreased as highly effective antiviral therapies have been established, the number of patients with steatohepatitis has been increasing.This retrospective study examined data of 229 patients from 22 hospitals in our region. We examined 155 cases of chronological data and assessed the development of liver fibrosis and evaluated hepatic reserve-related markers such as platelet count, FIB-4 index, prothrombin time, and serum albumin concentration. We analyzed the relationship of these chronological changes and the incidence of NAFLD related serious complications.Data related to liver fibrosis progression, albumin, and prothrombin time were significantly associated with the occurrence of serious complications associated with cirrhosis. We compared 22 event and 133 nonevent cases of chronological changes in the data per year and found that serum albumin concentration was significantly lower in the group that developed serious complications (event cases: -0.21 g/dL/year, nonevent cases: –0.04 g/dL/year (P < .001)). This albumin decline was only the associated factor with the event incidence by multivariate analysis (P < .01).Annual decline in serum albumin concentration in patients with NAFLD is associated with serious events from the outcome of multicenter retrospective study. This highlights its potential utility as a surrogate marker to assess the efficacy of prediction of NAFLD related serious events.

The Risk Assessment and Clinical Research of Bile Duct Injury After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma.

PurposeTo retrospectively evaluate the risk factors and the clinical outcomes of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and to evaluate factors that aid clinical detection and subsequent treatment of the injured bile duct.Materials and MethodsAll patients undergoing TACE for HCC were retrospectively reviewed for identification of bile duct injury. The clinical spectrum of all the patients analyzed including patients’ demographics, laboratory data, radiologic imaging and mode of treatment.ResultsFrom January 2015 to December 2017, a total of 21 patients (4.3%) out of 483 patients with 693 TACE procedures were identified to have bile duct injury at our single institution. There were 17 males and 4 females, with a mean age of 59.8±11.6 years (range 34–84). About 14.3% (3/21) patients show the high-density shadow around the bile duct wall in one week non-enhanced CT, and 76.2% (16/21) cases ALP>200 U/L, all these patients showed bile duct injury on the subsequent follow-up CT. Post-TACE follow-up blood biochemistry showed that alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) increased significantly compared with pre-TACE level. The incidence of various types of bile duct injuries on CT was intrahepatic bile duct dilatation (57.1%), biloma (25.7%) and hepatic hilar biliary strictures (17.1%), respectively. Patients with prior hepatectomy as well as proximal arterial chemoembolization carried a higher risk of post-TACE bile duct injury in terms of microvascular damage to the peribiliary capillary plexus.ConclusionBile duct injury complicating TACE is not caused by a single factor, but by a variety of factors, and is closely related to the microvascular compromise of the bile ducts and subsequent chronic biliary infection. Lipiodol deposited along the bile duct wall and the sharp rise of ALP>200 U/L in one week after TACE can predict bile duct injury and early intervention may prevent the occurrence of serious complications. The probability of bile duct injury in patients with prior hepatectomy and proximal arterial chemoembolization increases significantly.