Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 7 Articles
Background\nBariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence\nof the long-term effects of contemporary surgery on a broad range of clinical outcomes\nin large populations treated in routine clinical practice is lacking. The objective of this\nstudy was to measure the association between bariatric surgery, weight, body mass index,\nand obesity-related co-morbidities.\nMethods and Findings\nThis was an observational retrospective cohort study using data from the United Kingdom\nClinical Practice Research Datalink. All 3,882 patients registered in the database and with\nbariatric surgery on or before 31 December 2014 were included and matched by propensity\nscore to 3,882 obese patients without surgery. The main outcome measures were change\nin weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus\n(T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive\nsleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight\nmeasures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5\nand 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery\npatients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98\nkg/mo (95% CI 4.88ââ?¬â??5.08). Slower weight loss was sustained to the end of 4 y. Gastric\nbypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial\nweight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were\ndetected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55ââ?¬â??0.83); hypertension,\n0.35 (95% CI 0.27ââ?¬â??0.45); angina, 0.59 (95% CI 0.40ââ?¬â??0.87);MI, 0.28 (95% CI 0.10ââ?¬â??0.74);\nand obstructive sleep apnoea, 0.55 (95% CI 0.40ââ?¬â??0.87). Strong associations were found\nbetween bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84ââ?¬â??12.62), and between bariatric surgery and the resolution of hypertension, with a HR of 5.64\n(95% CI 2.65ââ?¬â??11.99). No association was detected between bariatric surgery and fractures,\ncancer, or stroke. Effect estimates for mortality found no protective association with bariatric\nsurgery overall, with a HR of 0.97 (95% CI 0.66ââ?¬â??1.43). The data used were recorded for the\nmanagement of patients in primary care and may be subject to inaccuracy, which would\ntend to lead to underestimates of true relative effect sizes.\nConclusions\nBariatric surgery as delivered in the UK healthcare system is associated with dramatic\nweight loss, sustained at least 4 y after surgery. This weight loss is accompanied by substantial\nimprovements in pre-existing T2DM and hypertension, as well as a reduced risk of\nincident T2DM, hypertension, angina, MI, and obstructive sleep apnoea. Widening the\navailability of bariatric surgery could lead to substantial health benefits for many people who\nare morbidly obese....
Background: This study aimed to compare Smith-Petersen osteotomy (SPO), poly-segmental wedge osteotomy\n(PWO) and pedicular subtraction osteotomy (PSO) in patients with rigid thoracolumbar kyphosis primarily caused\nby ankylosing spondylitis. The efficiency, efficacy and safety of these three osteotomies have not been compared\nsystematically, and no illness-oriented surgical type selection strategy for the treatment of ankylosing spondylitis\nrelated to non-angular kyphosis has been reported.\nMethods: The inclusion and exclusion criteria were defined, and 19 electronic databases were searched for eligible\nstudies without language limitations. For the included studies, data extraction, bias analysis, heterogeneity\nanalysis and quantitative analysis were performed to analyze the correction of kyphosiskyphosis and the\nincidence of complications.\nResults: Nine comparative studies that met the standards were included with a total of 539 patients that\nunderwent SPO (n = 120), PWO (n = 119), or PSO (n = 300). The correction of kyphosis by PSO was 8.74�°\n[95 % CI: 0.7-16.78] greater than SPO. The correction of kyphosis by PWO was 13.88�° [95 % CI: 9.25-18.51]\ngreater than SPO. For local biomechanical complications, the pooled risk ratio of PWO to PSO was 1.97\n[95 % CI: 1.03-3.77]. For blood loss, PSO was 806.42 ml [95 % CI: 591.72-1021.12] greater than SPO and\n566.76 ml [95 % CI: 129.80-1003.72] greater than PWO.\nConclusions: To treat rigid thoracolumbar kyphosis, PSO showed higher efficiency and efficacy than SPO, and\nPWO had a higher efficacy than SPO. The risk of local biomechanical complications was greater in PWO than\nPSO. Bleeding was more severe in PSO than in SPO or PWO. The incidence of neural complications and\nsystemic complications was similar....
Objective: To evaluate the efficacy and safety of culdotomy in surgical tubal sterilization and\nextrauterine tubal pregnancy, ruptured or intact.\nMethods: This is a prospective study of 11 cases of extrauterine tubal pregnancy and 29 cases of\ntubal sterilization subjected to transvaginal adnexal surgery via culdotomy from 2009-2014.\nResults: We reviewed 29 cases of culdotomic tubal sterilization as well as 11 cases of\nextrauterine tubal pregnancy of which 5 were intact and 6 were ruptured with hemoperitoneum.\nCuldotomic transvaginal tubal surgery was performed in all cases. There were no intraoperative\nor postoperative complications. Two units of blood were transfused in 2 cases of ruptured tubal\npregnancy. Cases were selected via history and physical exam; transvaginal ultrasound excluded\ncases with peritoneal adhesions which make culdotomy impossible.\nConclusion: Culdotomy is a safe surgical method to enter the cul-de-sac (pouch of Douglas) and\nto perform tubectomy for sterilization as well as for tubal ectopic pregnancy, either ruptured or\nintact....
Background: The interaction of depression and anesthesia and surgery may result in significant increases in\nmorbidity and mortality of patients. Major depressive disorder is a frequent complication of surgery, which may\nlead to further morbidity and mortality.\nLiterature search: Several electronic data bases, including PubMed, were searched pairing ââ?¬Å?depressionââ?¬Â with\nsurgery, postoperative complications, postoperative cognitive impairment, cognition disorder, intensive care unit,\nmild cognitive impairment and Alzheimerââ?¬â?¢s disease.\nReview of the literature: The suppression of the immune system in depressive disorders may expose the patients\nto increased rates of postoperative infections and increased mortality from cancer. Depression is commonly\nassociated with cognitive impairment, which may be exacerbated postoperatively. There is evidence that acute\npostoperative pain causes depression and depression lowers the threshold for pain. Depression is also a strong\npredictor and correlate of chronic post-surgical pain. Many studies have identified depression as an independent\nrisk factor for development of postoperative delirium, which may be a cause for a long and incomplete recovery\nafter surgery. Depression is also frequent in intensive care unit patients and is associated with a lower health-related\nquality of life and increased mortality. Depression and anxiety have been widely reported soon after coronary artery\nbypass surgery and remain evident one year after surgery. They may increase the likelihood for new coronary artery\nevents, further hospitalizations and increased mortality. Morbidly obese patients who undergo bariatric surgery have\nan increased risk of depression. Postoperative depression may also be associated with less weight loss at one year\nand longer. The extent of preoperative depression in patients scheduled for lumbar discectomy is a predictor of\nfunctional outcome and patientââ?¬â?¢s dissatisfaction, especially after revision surgery. General postoperative mortality is\nincreased.\nConclusions: Depression is a frequent cause of morbidity in surgery patients suffering from a wide range of\nconditions. Depression may be identified through the use of Patient Health Questionnaire-9 or similar instruments.\nCounseling interventions may be useful in ameliorating depression, but should be subject to clinical trials....
Background: Metastases to the pancreas are rare, accounting for less then 2 % of all pancreatic malignancies.\nHowever, both the benefit of extended tumor resection and the ideal oncological approach have not been\nestablished for such cases; therefore, we evaluated patients with metastasis to the pancreas who underwent\npancreatic resection.\nMethods: Between 1994 and 2012, 676 patients underwent pancreatic surgery in our institution. We retrospectively\nreviewed patientsââ?¬â?¢ medical records according to survival, and surgical and non-surgical complications. Studentââ?¬â?¢s t-test\nand the log-rank test were used for statistical analysis.\nResults: Eighteen patients (2.7 %) received resection for pancreatic metastases (12 multivisceral resections and\n6 standard resections). The pancreatic metastases originated from renal cell carcinoma (n = 10), malignant melanoma\n(n = 2), neuroendocrine tumor of the ileum (n = 1), sarcoma (n = 1), colon cancer (n = 1), gallbladder cancer (n = 1),\ngastrointestinal stromal tumor (n = 1), and non-small cell lung cancer (n = 1). The median time between primary\nmalignancy resection to metastasectomy was 83 months (range, 0ââ?¬â??228 months). Minor surgical complications\n(Grade I-IIIa) occurred in six patients (33.3 %) whereas major surgical complications (Grade IIIb-V) occurred in three\npatients (16.6 %). No patients died during hospitalization. The median follow-up was 76 months (range, 10ââ?¬â??165\nmonths). One-year, 3-year and 5-year survival for standard resection versus multivisceral resection was 83, 50, and\n56 % versus 83, 66, and 50, respectively. Twelve patients died after a median of 26 months (range, 5ââ?¬â??55 months).\nConclusions: A surgical approach with curative intent is justified in select patients suffering from metastases to\nthe pancreas and offers good long-term survival. The resection of pancreatic metastases of different tumor types\nwas associated with favorable morbidity and mortality when compared with resection of the primary pancreatic\nmalignancies. Our findings also demonstrated that multivisceral resection was feasible, with acceptable long term\noutcomes, even though morbidity rates tended to be higher after multivisceral resection than after standard resection....
Purpose. Surgical site infections (SSIs) remain a significant problem after laparotomies. The aim of this review was to assess the\nevidence on the efficacy of subcutaneous wound drainage in reducing SSI. Methods.MEDLINE database was searched. Studies were\nidentified and screened according to criteria to determine their eligibility for meta-analysis. Meta-analysis was performed using\nthe Mantel-Haenszel method and a fixed effects model. Results. Eleven studies were included with two thousand eight hundred\nand sixty-four patients. One thousand four hundred and fifty patients were in the control group and one thousand four hundred\nand fourteen patients were in the drain group.Wound drainage in all patients shows no statistically significant benefit in reducing\nSSI incidence. Use of drainage in high risk patients, contaminated wound types, and obese patients appears beneficial. Conclusion.\nUsing subcutaneous wound drainage after laparotomy in all patients is unnecessary as it does not reduce SSI risk. Similarly, there\nseems to be no benefit in using it in clean and clean contaminated wounds.However, there may be benefit in using drains in patients\nwho are at high risk, including patients who are obese and/or have contaminated wound types.A well designed trial is needed which\nexamines these factors....
Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options\nin the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable\ncancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity,\nlocally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If\ntechnically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat\nsurgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy) may often be complicated,\nand perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer\nspecific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and\nrobotic approach) and nonsurgical alternatives (cryoablation, radiofrequency ablation) have yet to be described. In selected patients,\nsurgical resection may have to be complemented with (neo)adjuvant radiotherapy or medical treatment....
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