Complication Rate In Group Research Articles

Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device.

The necessity for platelet-inhibition testing before aneurysm treatment in patients premedicated with antiplatelet agents is controversial. Using the International Retrospective Study of Pipeline Embolization Device registry, we studied complication rates in groups of patients who underwent platelet testing and those who did not undergo platelet testing to determine if these test results were associated with improved outcomes. Patients in the International Retrospective Study of Pipeline Embolization Device registry with an unruptured aneurysm were categorized as those who underwent platelet testing before Pipeline embolization device treatment or those who did not. Complication rates were compared by using the Fisher exact or Pearson χ(2) test. Multivariate analysis was performed to determine if platelet function testing was independently associated with poor outcomes after adjusting for age, number of devices and aneurysms, aneurysm location and size, and practitioner and center volume. Compared with the patients who received a Pipeline embolization device without platelet testing, those who underwent platelet testing and Pipeline embolization device placement experienced higher rates of intracranial hemorrhage (0 of 187 [0.0%] vs 12 of 511 [2.3%], respectively; P = .04), neurologic morbidity (4 of 187 [2.1%] vs 42 of 511 [8.2%], respectively; P < .01), and combined neurologic morbidity and mortality (6 of 187 [3.2%] vs 45 of 511 [8.8%], respectively; P = .01). More patients in the platelet testing and Pipeline embolization device group were treated with multiple devices (227 [38.0%] vs 56 [27.8] patients, respectively; P = .01). On multivariate analysis, the group of patients who underwent platelet testing and Pipeline embolization device placement had higher odds of neurologic morbidity (OR, 3.25 [95% CI, 1.10-9.61]; P = .03). Platelet testing in patients who undergo Pipeline embolization device placement is associated with higher rates of morbidity. Additional prospective studies are needed to determine if and when platelet testing in these patients is appropriate.

Randomized study of different approaches for catheter-directed thrombolysis for lower-extremity acute deep venous thrombosis.

To investigate the feasibility, effectiveness, and complications of catheter-directed thrombolysis (CDT) using three different approaches for acute lower-extremity deep venous thrombosis (DVT). A total of 106 patients with acute DVT were enrolled in this study. Forty-one patients received CDT through the small saphenous vein (Group A), 35 through the great saphenous vein (Group B), and 30 through the popliteal vein (Group C). Iliac vein balloon dilation and stenting was performed in 65 cases. The vascular approach route was not statistically related to limb edema reduction rates (Groups A, B, and C: 82.3±7.6% vs. 81.6±6.0% vs. 83.9±6.1%), nor to thrombolysis rates (63.5±7.7% vs. 66.9±8.4% vs. 66.1±2.7%). The procedure was significantly shorter for Groups B and C. No significant difference was found between Groups B and C. Most complications occurred in Group A. The complication rate in Group B was the lowest. Eighty-eight patients were followed up for 7-24 months. Of these, 78 were pain-free and without limb edema; six showed rethrombosis. CDT is an effective method to manage acute DVT. Of the three routes tested, the small saphenous vein route was associated with more frequent complications. Great saphenous vein catheterization was more effective because of its lower complication rate.

Laparoscopic adrenalectomy for pheochromocytoma is more difficult compared to other adrenal tumors.

IntroductionLaparoscopic adrenalectomy is the gold standard for the treatment of benign adrenal tumors. However, some authors raise the problem of differences in surgery for pheochromocytoma in comparison to other lesions.AimTo compare laparoscopic adrenalectomy for pheochromocytoma and for other tumors.Material and methodsFour hundred and thirty-seven patients with adrenal tumors were included in the retrospective analysis. Patients were divided into two groups: 1 (124 patients treated for pheochromocytoma) and 2 (313 patients with other types of tumor). The two groups were compared with respect to mean operative time, intraoperative blood loss, conversion rate, complication rate and the relationship of tumor size with operative time.ResultsThe mean operative time in group 1 was 91 min, and in group 2 it was 82 min (p = 0.016). In both groups 1 and 2, tumor size correlated with operative time (p < 0.0001 and p = 0.0003, respectively). The mean blood loss in groups 1 and 2 was 117 ml and 54 ml, respectively (p = 0.0011). The complication rate in groups 1 and 2 was 4% and 4.2%, respectively (p = 0.9542). In groups 1 and 2, conversion was necessary in 2 (1.6%) and 5 (1.6%) cases, respectively (p = 0.9925).ConclusionsLonger operative time and higher blood loss after laparoscopic adrenalectomy for pheochromocytoma indicate its greater difficulty. However, despite these drawbacks, minimally invasive surgery still seems to be an effective and safe method.

Effectiveness of a compressive device in controlling hemorrhage following radial artery catheterization.

ObjectiveThe purpose of this study was to evaluate the effectiveness of a compressive device in controlling hemorrhage following radial artery catheterization.MethodsA prospective randomized trial was conducted on subjects receiving the standard taping method (group S) compared to a compressive device method (group C) after removal of the cannula in radial artery catheterization. Primary outcomes were the success rate of hemostasis and complication rate after cannula removal. Secondary outcomes were the cost of compression and the level of convenience.ResultsA total of 250 subjects were enrolled in this study. Hemostasis after removal was successful in 122 of 125 (97.6%) subjects in group S and 116 of 125 (92.8%) subjects in group C (P=0.18). Complication rates in group S and group C were 55.2% (69/125) and 48% (60/125), respectively (P=0.35). The cost of compression for group C (approximately 6,740 Korean won) was approximately two times cheaper than for group S (approximately 14,140 Korean won). The level of convenience was significantly higher in group C than in group S (7.4±2.1 vs. 3.7±1.9, p < 0.001).ConclusionThese findings suggest that hemostasis using a compressive device may be a suitable alternative method to the standard taping method in controlling hemorrhage following radial artery cannulation.

Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis.

The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis. A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle > 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3-5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°-75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle > 60°) were used as a control group (Group B). In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°-24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200-8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°-34°), and there was no significant loss of correction (p > 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p < 0.05). An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis resulted in significant reduction of the kyphotic angle, few complications, and good follow-up results. However, a larger series of patients and long-term follow-up results is still required to verify the effectiveness and safety of this method.

The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale

Background contextThere have been no previous studies looking at the outcome of surgical decompression (+/−stabilization) for various grades of epidural spinal cord compression (ESCC) due to spinal metastases. PurposeThe aim of this study was to determine the outcome of surgical treatment in patients with ESCC using the Bilsky six-point scale. Study design/SettingThis was a retrospective cohort review of prospectively collected data. Patient sampleA consecutive series of 101 patients managed over the period of 3 years for ESCC due to spinal metastases in a tertiary spine surgery referral unit were included. MethodsData on age, gender, revised Tokuhashi score, preoperative Frankel grade, tumor histology, magnetic resonance imaging scan–based Bilsky cord compression grade, postoperative Frankel grade at last follow-up, complications, and survivorship were collected. Outcome measuresFrankel grading system for function was used to evaluate the patient's preoperative and postoperative neurologic status. Patient survival and postoperative complications were also collected. ResultsAverage patient age was 64.7 years (13–88 years): 62 males and 39 females. Mean follow-up was 7.3 months (3–23.3 months). Most primary tumors were in prostate, breast, renal, lung, and the blood dyscrasias. Within the lower grade of compression (Group 1; Bilsky Grades 0,1a, 1b, and 1c; n=40), 29 patients (72.5%) had no improvement in Frankel grade, seven patients (17.5%) improved, whereas four patients (10%) deteriorated neurologically after surgery. Within the higher compression grade (Group 2; Bilsky Grades 2 and 3; n=61), 37 patients (60%) did not experience neurologic change, 20 (33%) improved, whereas neurology worsened in four patients (7%). When compared with Group 2 patients, Group 1 patients had better preoperative Frankel scores but a greater number of patients in Group 2 improved their Frankel scores significantly postoperatively. The mean revised Tokuhashi score for Groups 1 and 2 was 10 and 9.1, respectively (p=.1). The complication rate for Groups 1 and 2 was 25% and 42.6%, respectively (p=.052). Survival analysis showed no difference between the groups (Group 1: median 376 days [12–1052]; Group 2: median 326 days [12–979]; p=.62). ConclusionsSurgery can achieve improvements in neurology even in higher grades of cord compression. There is a trend toward more complications and worse survival with spinal surgery in patients with higher grades of compression.

Therapeutic effect comparison between unipolar and bipolar radiofrequency ablation in treating atrial fibrillation in elderly patients

Objective To compare clinical effect of unipolar versus bipolar radiofrequency ablation in treating atrial fibrillation (AF) in elderly patients and discuss the correlated risk factors. Methods From October 2008 to December 2013, a total of 50 elderly patients with organic heart disease and AF underwent radiofrequency ablation surgery. All patients were divided into 2 groups of unipolar (group A, n= 20) and bipolar (group B, n=30 patients) radiofrequency ablations. The variations of electrocardiogram (ECG) and ultrasonic cardiogram (UCG) in patients were collected and the complications and the NYHA class of the patients were recorded at 3, 6 and 12 months after surgery. The total 43 elderly patients were divided into sinus group and non-sinus group according to their ECG at 12 months after surgery. Results The recovery rates of sinus rhythm at 3, 6 and 12 months after surgery were 73.7%(14/19), 66.7%(12/18) and 61.1% (11/18)respectively in group A and 82.8%(24/29), 85.2%(23/27)and 88.0%(22/25) respectively in group B. Two groups of the recovery rate of sinus rhythm had a statistically significant difference between the two groups (P<0.05) at 12 months after surgery. The complication rate in group A was higher than in group B 〔55.0% (11 cases) vs. 26.7% (8 cases), P<0.05〕. Preoperative history of AF and left atrial diameter were the influencing factors for the sinus rhythm recovery rates (P<0.05). Conclusions Bipolar radiofrequency ablation for AF is safe and has less complications and high success rate of restoring sinus rhythm. The patients with long preoperative history of AF and left atrium distension have a low success rate of restoring sinus rhythm with a high recurrence rate. Key words: Atrial fibrillation; Catheter ablation

Administration of low-dose cyclosporine alone for the treatment of elderly patients with membranous nephropathy.

This study aimed to investigate the effects of administration of low-dose cyclosporine A (CsA) alone and the combination of low-dose CsA and a low-dose hormone for the treatment of elderly patients with membranous nephropathy. We divided 27 patients into two groups as follows: low-dose CsA group (group A) and the group receiving a combination of a low-dose hormone and low-dose CsA (group B). The treatment and follow-up times were ≥ 6 months. We observed no difference in gender, age, serum creatinine levels, estimated glomerular filtration rate (eGFR), and 24-h urinary protein levels between the two groups before treatment; in addition, the rates of complete and partial remission were not different 6 months after treatment. The rate of complications in group B was higher than that in group A (84.6 vs 35.7%, respectively; t = 0.018). While the pretreatment eGFR of patients who achieved remission was significantly higher than that of patients who did not achieve remission, the 24-h urinary protein levels and incidence of hypertension were significantly lower than those of patients who did not achieve remission (t = 0.042, 0.035 and 0.043, respectively). The efficacy of administration of low-dose CsA alone and in combination with a low-dose hormone was similar; the efficacy was related to eGFR, urinary protein levels, and the incidence of hypertension before the treatment. The side effects of administration of CsA alone were significantly lower than those of the combination treatment.

Complication Rate and Clinical Result of One-Week Interval Staged Bilateral Total Knee Arthroplasty: Compared to Simultaneous and Several-Months Interval Staged Bilateral Total Knee Arthroplasty

Purpose: The purpose of this study is to compare the clinical results and the rates of complication among three groups that received the simultaneous total knee replacement (TKR), one-week interval staged bilateral TKR, or several-months interval staged TKR. Materials and Methods: We conducted a retrospective study of patients who had been diagnosed with bilateral degenerative osteoarthritis undergoing bilateral TKR from 2004 May to 2012 March. We divided patients into three groups which received simultaneous TKR (Group A, n=84), one-week interval staged bilateral TKR (Group B, n=124), or several-months interval staged TKR (Group C, n=65). Hospital for special surgery (HSS) score and the rate of complication were evaluated and compared. Results: Mean postoperative HSS score showed significant improvement in the three groups. No difference in postoperative HSS was observed among the three groups (p=0.325). The complication rate in Group A was lower than that in Group B (p=0.049) and that in Group A was similar to that in Group C (p=0.786). Conclusion: Group A had a better result than Group B and was similar to Group C in complication rate. One-week interval staged TKR can be good choice in patients with bilateral degenerative osteoarthritis.

The operation timing and effect of minimally invasive surgical drill drainage in the treatment of hypertensive intracerebral hemorrhage

Objective To explore and analyze the optimal timing of surgery and clinical efficacy of minimally invasive drilling drainage in the treatment of hypertensive cerebral hemorrhage .Methods 150 patients with hyperten-sive cerebral hemorrhage ,according to a random number table method ,were randomly divided into the three groups , 50 patients in each group.Patients in group A received minimally invasive drainage drilling within 6h after the onset of disease,patients in group B received minimally invasive surgery 6-24h after the onset,patients in group C were given elective minimally invasive surgery 24-72h after the onset.Another 50 patients with hypertensive cerebral hemorrhage who received craniotomy surgery over the same period ,were selected as the control group .The clinical effects were observed and compared in four groups .Results The total effective rate of group B was 88%,which was significantly higher than the other three groups （χ2 =4.00,6.38,12.70,all P〈0.05）.The early cure rate of the observation group was 40%,which was significantly higher than the control group （χ2 =8.57,P〈0.05）.After treatment,the number of cases whose activities of daily living degree recovered to grade I in the observation group was significantly higher than the other three groups （χ2 =4.11,5.00,8.32,all P〈0.05）.The excellent rate of group B was 88%（44/50）,which was significantly higher than the other three groups （χ2 =6.83,5.83,15.43,all P〈0.05）.After treatment,the incidence rate of complications in group B was significantly lower than the other three groups ,the inci-dence rate of complications in the control group was the highest （χ2 =5.32,8.58,32.97,all P〈0.05）.Conclusion Minimally invasive drilling drainage in the treatment of hypertension cerebral hemorrhage can obtain significant effect , the optimal timing of surgery is 6-24h,minimally invasive treatment has advantages of less invasive ,faster recovery,fe-wer complications ,and less costs ,which is worthy of widely used in clinical practice . Key words: Intracranial hemorrhage, hypertensive; Minimally invasive drilling drainage

Transvaginal surgical management of cesarean scar pregnancy: analysis of 49 cases from one tertiary care center

ObjectiveTo investigate the safety and effectiveness of transvaginal surgical management of cesarean scar pregnancy (CSP). Study designRetrospective analysis of 49 CSP patients who received transvaginal surgery in our hospital between December 2009 and April 2013. Patients were divided into two groups. Group A (30 patients) was defined as patients who had not received any treatment before transvaginal surgical management. Group B (19 patients) referred to patients who had received any previous treatment. Preoperative, intraoperative and postoperative data of both groups were collected and analyzed retrospectively. ResultsPreoperative serum β-hCG level, preoperative hemoglobin level and average serum β-hCG resolution time of group A and group B were 53,458.50 (36,382.00–94,100.50) versus 9779.00 (932.50–29623.00)U/l, 123.87±10.95 versus 109.94±16.05g/l and 3.55±1.81 versus 1.83±1.15 weeks (P<0.05). Vaginal bleeding and gestational age in group A were significantly lower than in group B, 2.5 (0.50–11.00) versus 15.00 (3.50–31.50) days and 52.50 (46.50–56.70) versus 60.00 (48.00–90.00) days, respectively (P<0.05). The operative time, estimated blood loss, postoperative hospital stay, hospitalization expenses and menstruation recovery time of group A and group B were 56.61±24.40 versus 67.56±43.52min, 45.65±27.83 versus 76.67±50.87ml, 5.10±2.89 versus 5.33±3.99 days, 9001.94±1848.37 versus 11,032.33±5534.14 RMB and 1.16±0.47 versus 1.26±0.63 month respectively, which were similar between the two groups (P>0.05). The intraoperative complication rate in group A was significantly lower than group B, 0 (0/30) versus 21.05% (4/19) (P<0.05). The postoperative complication rate and total complication rate in group A and group B were 10.00% (3/30) versus 21.05% (4/19) and 10.00% (3/30) versus 31.58% (6/19) (P>0.05), respectively. ConclusionTransvaginal surgery is an effective and relatively safe treatment option for CSP patients.

Bone-Supported Arch Bars Are Associated With Comparable Outcomes to Erich Arch Bars in the Treatment of Mandibular Fractures With Intermaxillary Fixation

Titanium arch bars that are directly fixated to the maxilla and mandible with self-drilling locking screws combine features of Erich arch bars and bone-supported devices and present an alternative method of intermaxillary fixation (IMF) that possesses potential advantages over existing techniques. The objective of this study was to compare IMF using this device with Erich arch bars secured with circum-dental wires. A retrospective cohort study was performed of patients who were surgically treated for mandibular fractures from 2012 through 2013. The primary predictor variable was fixation technique, which was IMF using Erich arch bars secured with circum-dental wires (group I) or titanium arch bars fixated with maxillary and mandibular screws (group II). The outcome variables were complication rates, time necessary for device application and removal, glove perforation rate, and cost. Statistical analysis was performed with InStat (GraphPad, Inc, La Jolla, CA) using the Fisher, χ(2), or Mann-Whitney test, as appropriate. Twenty-five consecutive cases in group I and in group II were reviewed. There were 43 male patients (86%) and 7 female patients (14%) with a mean age of 28.4 years. Mean follow-up was 2.0 months. Overall complication rates for groups I and II were similar (16.0% vs 12.0%, respectively; P = 1.00). In group II, there were 3 instances of delayed wound healing at the sites of gingivobuccal incisions attributed to the close proximity of the arch bar eyelets. The time necessary for device application was faster in group II than in group I (42 vs 62 minutes, respectively; P = .02). Bone-supported arch bars may be a comparable alternative to Erich arch bars secured with circum-dental wires for IMF. Careful planning of transoral incisions in relation to locking screw eyelets may help minimize wound complications.

Discussion on digital subtraction guided transbronchial lung biopsy in diagnosis of peripheral pulmonary lesions

Objective To explore the diagnostic value of transbronchial lung biopsy (TBLB) under digital subtraction (DSA) positioning in peripheral pulmonary lesions.Methods From November 2009 to December 2013,86 patients with peripheral pulmonary lesions were divided into group A and group B.Group A underwent transbronchial lung biopsy under DSA location,bronchoscopy brush (BB) and bronchoalveolar lavage (BAL),while group B underwent percutaneous lung biopsy under CT positioning.The positive rate of diagnosis results,the positive rate of group A than in the three methods of PCNA and TBLB,the diagnostic results of BB compared to BAL,and complications of two groups after the treatment were compared.Results There were no statistically significant differences in positive rate between any two of TBLB,BB,BAL (x2=0.84,0.54,0.16; P ＞ 0.05).There were no statistically significant differences in positive rate between PCNA and any one of TBLB,BB,BAL (x2=0.12,0.06,0.22; P ＞ 0.05).The positive rate of the combination of TBLB,BB and BAL was 83.72％ (36/43),significantly higher than 69.77％ (30/43) of PCNA,with statistically significant difference (P ＜ 0.05).The complication rate in group A was significantly lower than that in group B (13.95％ vs.30.23％),with statistically significant difference (P ＜ 0.05).Conclusion TBLB,BB,BAL,PNCA all have a high value in the diagnosis of peripheral pulmonary lesions.BB,BAL after TBLB can improve the positive rate of diagnosis,at the same time DSA positioning can significantly reduce the incidence of complications. Key words: Digital subtraction; Transbronchial lung biopsy; Peripheral pulmonary lesions

Comparative Analysis of Pedicular Vascular Control Techniques during Laparoscopic Nephrectomy: En Bloc Stapling or Separate Ligation?

Objective: To compare the safety and efficacy of en bloc stapling and separate ligation techniques for renal vascular control during laparoscopic nephrectomy. Patients and Methods: Clinical data were collected from 60 patients who underwent laparoscopic nephrectomies using en bloc stapling (n = 27, group 1) or the separate ligation method (n = 33, group 2). Comparative analysis was carried out between the two groups, examining operative times, blood loss, intra- and postoperative complications and hospital stay. Results: Compared with the separate ligation method, the en bloc hilar control technique was associated with a shorter total operating time (98 vs. 121 min, p = 0.029). However, both groups were similar in terms of estimated blood loss, hemoglobin drop, changes in creatinine level and postoperative hospital stay. The total complication rates in group 1 and 2 were 3.7 and 15.1%, respectively, with a statistically significant difference. There were no complications related to the use of the endo-GIA stapler and no patients required conversion to open surgery in group 1. In group 2, 2 patients required conversion to open surgery, including 1 due to renal vein bleeding secondary to inaccurate vascular control and the other due to bleeding from the vena cava during dissection. In addition, 1 patient had a superficial bowel injury that was repaired laparoscopically and another had a superficial liver tear that was managed without conversion or transfusion. Conclusion: En bloc ligation of the renal hilum is an easy and reliable technique that allows safe and fast control of the renal pedicle.

Complications After Tracheal and Cricotracheal Resection and Anastomosis for Inflammatory and Neoplastic Stenoses

This study aimed to evaluate complications and success rates of tracheal resection and anastomosis (TRA) and cricotracheal resection and anastomosis (CTRA) in patients treated in 2 academic institutions. Retrospective charts review of 137 patients submitted to TRA/CTRA. Fifty (36.5%) had neoplastic (group A) and 87 (63.5%) benign (group B) stenoses. Using univariate analysis, age, medical comorbidities, previous radiotherapy, type of TRA/CTRA, association with neck dissection and thyroidectomy, length of resected airway, and preoperative tracheotomy were evaluated to identify factors predictive of complications and outcomes. The mean length of resected airway was 2.7 and 3 cm in groups A and B, respectively. Overall decannulation and complication rates for group A were 96% and 36%, and 99% and 46% for group B, respectively. Length of airway resected and presence of preoperative tracheotomy had a statistically significant effect on major surgical complications. Age older than 70 and cardiovascular and pulmonary comorbidities were significantly associated with the incidence of major medical complications. No statistically significant difference was found considering the complication rates of group A versus group B. Even though the overall success rate of TRA/CTRA is high, it should always be regarded as a major surgical procedure with a non-negligible incidence of complications.

Learning curve for breast mass excision using a vacuum-assisted biopsy system

Background: Vacuum-assisted breast biopsy system (VAB) is an alternative modality to core needle biopsy for the diagnosis of breast lesions. Material and methods: Fifty-four patients who underwent ultrasound-guided VAB procedures were analyzed. Patients were categorized into two groups: The first 20 consecutive patients as group A and the next 34 consecutive patients as group B. Results: Fifty-two patients underwent excision, and two underwent biopsy only. Moving average curves showed a plateau phase for performing VAB procedures after the 20th patient. Total operation times of group B were significantly shorter than those of group A (p < 0.001). Complication rates in group B tended to be lower, and VAB probe position of group B tended to be better than that of group A, but these differences were not statistically significant. Conclusion: Our data suggest the existence of a learning curve for ultrasound-guided VAB procedures. VAB procedures can be performed safely, even during the early learning period.

Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures

ObjectiveThe objective of this study was to compare treatment results and complication rates between lateral and posterior approaches in surgical treatment of extra-articular distal humeral shaft fractures. Material and methodsBetween June 2008 and May 2012, a total of 68 patients with extra-articular distal humeral shaft fractures were treated by lateral and posterior approaches. Of the patients, 30 were operated by a lateral approach (group I) and 26 patients were operated by a posterior approach (group II). There was no statistical significance between the two groups in sex distribution, age, the mechanism of the injury, injured arms, AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) classification, and the time from injury to surgery (P>0.05). Operation time, intraoperative bleeding volume, hospitalisation, clinical outcomes, and complications were compared between the two groups. The elbow functional results were evaluated by the Mayo Elbow Performance Score (MEPS). ResultsAll patients were followed up. The average of follow-up in group I was 15.53±2.636 months (range, 12–22 months), and was 16.12±2.889 months (range, 12–22 months) in group II. There was no significant difference in the operation time, intraoperative bleeding time, and hospitalisation between the two groups (P>0.05). In group I, the mean time of bone union was 12.87±1.852 weeks (range, 10–16 weeks), the mean degrees of elbow flexion was 139.20°±3.274° (range, 134–146°), the mean degrees of elbow extension was 4.77°±1.906° (range, 0–8°), and the mean points of MEPS was 87.00±7.724 (range, 70–100 points). In group II, the mean time of bone union was 12.96±2.218 weeks (range, 10–16 weeks), the mean degrees of elbow flexion was 137.85°±4.076° (range, 130–145°), the mean degrees of elbow extension was 5.15°±2.327° (range, 0–9°), and the mean points of MEPS was 86.15±7.656 (range, 70–100 points). There was no significant difference in the bone union, range of elbow flexion, range of elbow extension and MEPS between the two groups (P>0.05). The overall complication rate in group I was lower than that in group II (P=0.041). ConclusionsBoth lateral and posterior surgical approaches acquired satisfied treatment results in the management of extra-articular distal humeral shaft fractures, and there was a lower complication rate using the lateral approach.

The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and Subsequent Reduction in Perioperative Complication Rates

Study DesignRetrospective consecutive case review pre- and postintervention. ObjectivesCharacterize the effects of the intervention.Summary of Background Data: Complication rates in adult spinal deformity surgery are unacceptable. System approaches are necessary to increase patient safety. This group reported on the dual–attending surgeon approach, a live multidisciplinary preoperative screening conference, and the intraoperative protocol for the management of coagulopathy. The outcomes were demonstrated by complication rates before and after the institution of this protocol. MethodsForty consecutive patients in Group A were managed without the 3-pronged approach. A total of 124 consecutive patients in Group B had a dual–attending surgeon approach, were presented and cleared by a live multidisciplinary preoperative conference, and were managed according to the intraoperative protocol. ResultsGroup A had an average age of 62 years (range, 39–84 years). Group B had an average age of 64 years (range, 18–84 years). Most patients in both groups had fusions from 9 to 15 levels. Complication rates in Group B were significantly lower (16% vs. 52%) (p < .001). Group B showed significantly lower return rates to the operating room during the perioperative 90-day period (0.8% vs. 12.5%) (p < .001). Group B also had lower rates of wound infection requiring debridement (1.6% vs. 7.5%), lower rates of deep vein thrombosis/pulmonary embolism (3.2% vs. 10%), and lower rates of postoperative neurological complications (0.5% vs. 2.5%) (not significant). Group B had significantly lower rates of urinary tract infection requiring antibiotics (9.7% vs. 32.5%) (p < .001). ConclusionsThese data suggests that a team approach consisting of a dual–attending surgeon approach in the operating room, a live preoperative screening conference, and an intraoperative protocol for managing coagulopathy will significantly reduce perioperative complication rates and enhance patient safety in patients undergoing complex spinal reconstructions for adult spinal deformity.

The free TRAM versus extended latissimus dorsi flap in postmastectomy reconstruction: A comparative study

In currently avai!able literature the optimal flap choice for reconstructing post mastectomy breast has not yet defined. The free TRAM and extended latissimus dorsi flaps have been described for breast reconstruction. However comparison between them has not yet been described in our community. The current study was carried out to evaluate the two modalities in our society Patients and methods: 30 consecutive patients who underwent immediate unilateral breast reconstruction were included in the study. 15 patients had undergone extended latissimus dorsi flap (group A) and the other 15 had undergone free TRAM (group B). All patients were evaluated operatively, clinically for complications, aesthetic results and patient's satisfaction during the mean follow up time 10.7(4-19) months for group A and 11.9(6-19) months for group B. Results: The mean operative time, blood transfusion requirements, hospital stay and time to start post operative adjuvant therapy (3.67 hours, 666.6cc, 11.6days and 26.6days respectively) in group A patients were significantly less than for group B (8.8days,1666.6cc,17days and 39.2days respectively) withp value < 0.01. The rate of complications in group B (one anastomosis revision, 2partialflap necrosis, one hernia and one fat necrosis/33.33%) was higher than group A (one partial flap necrosis, one back scar disfigurement and 2seromas/26.67%). Higher patient's satisfaction was achieved in group A (93.3% satisfied to very satisfied) than in group B (79.9% satisfied to very satisfied) while aesthetic scoring was nearly similar in both groups. Conclusion: The extended latissimus dorsi flap could be as good as free TRAM regarding aesthetic outcomes, technically feasible flap with fewer complications. So we advocated offering the extended latissimus dorsi flap as the 1st choice for immediate post mastectomy reconstructions to selected patients.

Skin staples: a safe technique for securing mesh in lichtensteins hernioplasty as compared to suture.

Background. Lichtenstein tension free repair is the most commonly used technique due to cost effectiveness, low recurrence rate, and better patient satisfaction. This study was done to compare the duration of surgery and postoperative outcome of securing mesh with skin staples versus polypropylene sutures in Lichtenstein hernia repair. Materials and Methods. A total of 96 patients with inguinal hernia undergoing Lichtenstein mesh repair were randomly assigned into two groups. The mesh was secured either by using skin staples (group I) or polypropylene sutures (group II). Results. The operation time was significantly reduced from mesh insertion to completion of skin closure in group I (mean 20.7 min) as compared to group II (mean 32.7 min) with significant P value (P < 0.0001) and less complication rate in group I as compared to group II. Conclusion. Mesh fixation with skin staples is as effective as conventional sutures with added advantage of significant reduction in the operating time and complications or recurrence. The staples can be applied much more quickly than sutures for fixing the mesh, thus saving the operating time. Infection rate is significantly decreased with staples.