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1.
BACKGROUND CONTEXT
Patients with pyogenic vertebral osteomyelitis (PVO) are expected to have an increased risk of bone loss. Therefore, early bisphosphonate therapy would be clinically effective for PVO patients with osteoporosis.PURPOSE
This study aimed to investigate the effect of bisphosphonate on clinical outcomes of PVO patients with osteoporosis.STUDY DESIGN/SETTING
A retrospective comparative study.PATIENT SAMPLE
PVO patients with osteoporosis.OUTCOME MEASURES
Four events of interest for Cox proportional hazard model included surgical treatment, recurrence of infection, subsequent fracture of adjacent vertebral bodies, and death.METHODS
PVO patients were divided into three groups: group A (initiation of bisphosphonate within 6 weeks after PVO diagnosis), group B (initiation of bisphosphonate between 6 weeks and 3 months after PVO diagnosis), and group C (no treatment for osteoporosis). Cox proportional hazard model was used for the four events of interest.RESULTS
A total of 360 PVO patients with osteoporosis were investigated for the four events of interest. Group A had significantly lower hazard ratios for undergoing later (>6 weeks after diagnosis) surgery than group C (p?=?.014) despite similar occurrences of overall surgery. A significant difference was also observed in the occurrence of subsequent fractures at adjacent vertebral bodies (p?=?.001 for model 1 and p?=?.002 for model 2). Groups A and B had significantly lower hazard ratios for subsequent fracture than group C. No significant differences were observed in the hazard ratios of recurrence and death among the three groups.CONCLUSIONS
Early bisphosphonate treatment in PVO patients with osteoporosis was associated with a significantly lower occurrence of subsequent vertebral fracture at adjacent vertebral bodies and lower occurrence of subsequent surgery. 相似文献2.
Marc Danan Anamaria Nedelcu Patrick Noel Viola Zulian Sergio Carandina Marius Nedelcu 《Surgery for obesity and related diseases》2019,15(1):8-11
Background
Continuous developments in healthcare have led to an increase in average life expectancy. Obesity in aged persons is increasing and is more clearly associated with an increased risk of diabetes, cardiovascular disease, lipid abnormalities, mobility-limited problems, and other co-morbidities in this category of age.Objectives
The aim of the present study was to report the outcomes of laparoscopic sleeve gastrectomy in patients >65 years of age.Setting
Private hospital, France.Methods
A retrospective review was performed from patients aged >65 years who had undergone laparoscopic sleeve gastrectomy (June 2011–December 2017). The data analyzed included age, co-morbidities, preoperative body mass index, length of hospital stay, and postoperative complications.Results
A total of 93 patients were included with a mean age of 68.8 years (range, 65–78); 73 were female (78.5 %), and the mean preoperative body mass index was 43.6 ± 5.4 kg/m2. Revisional surgery was well represented in 34.4% of cases. Thirty-two patients had a previous gastric band converted to laparoscopic sleeve gastrectomy, with 12 cases of 1-step revision (37.5%). Eleven patients (11.8%) had concomitant cholecystectomy. All procedures were performed laparoscopically with no peroperative complications. The median hospital stay was 3.1 days (1–6 d). Complications included 1 hematoma treated conservatively. The 30-day mortality rate was 0%. The mean excess weight loss at 1 year postoperatively was 67.1% (range, 34%–107%) with a follow-up rate of 78.1%. Resolution or improvement was observed in 65% of patients presenting with diabetes, in 72.5% of patients presenting with HTA, in 47.1% of patients presenting with dyslipidemia, and in 63.6% of patients presenting with sleep apnea.Conclusions
Sleeve gastrectomy in elderly patients seems to be safe in terms of complications. Surgery is associated with a low-morbidity profile. Sleeve gastrectomy is our preferred procedure in this category of patients. 相似文献3.
Abel Boerboom Jens Homan Edo Aarts Theo Aufenacker Ignace Janssen Frits Berends 《Surgery for obesity and related diseases》2019,15(1):60-69
Background
For a number of years the laparoscopic adjustable gastric band has been one of the leading bariatric procedures with good short-term outcomes. However, inadequate weight loss, weight regain, and other band-related complications in the long term led to an increase in revisional Roux-en-Y gastric bypass (RYGB) procedures. Lengthening the biliopancreatic limb, a relatively simple and safe adjustment of the standard technique, could improve the results of the revisional procedure.Objectives
The aim of this randomized controlled trial was to evaluate the effect of a long biliopancreatic limb RYGB (LBP-GB) and standard RYGB (S-GB) as revisional procedure after laparoscopic adjustable gastric band.Setting
General hospital specialized in bariatric surgeryMethods
One hundred forty-six patients were randomized in 2 groups; 73 patients underwent an S-GB (alimentary/biliopancreatic limb 150/75 cm), and 73 patients underwent LBP-GB (alimentary/biliopancreatic limb 75/150). Weight loss, remission of co-morbidities, quality of life, and complications were assessed during a period of 4 years.Results
Baseline characteristics between the groups were comparable. At 48 months the follow-up rate was 95%. Mean total weight loss after 24 months was 27% for LBP-GB versus 22% S-GB (P?=?.015); mean total weight loss after 48 months was 23% and 18%, respectively (P?=?.036). No significant differences in other parameters were found between the groups.Conclusions
A LBP-GB as revisional procedure after a failing laparoscopic adjustable gastric band improves short- and long-term total weight loss compared with an S-GB. Together with future modifications this technically simple adjustment of the RYGB could significantly improve disappointing results after revisional surgery. 相似文献4.
Rena C. Moon Vincent Kirkpatrick Lori Gaskins Andre F. Teixeira Muhammad A. Jawad 《Surgery for obesity and related diseases》2019,15(2):245-252
Background
Biliopancreatic diversion with duodenal switch (DS) is known to be superior in weight loss to other bariatric procedures, but with the disadvantage of increased complication rates. Single-anastomosis duodenal-ileal bypass (SADI-S) is reported to have similar weight loss with lower complication rates compared with traditional DS.Objectives
The aim of this study was to compare weight loss and complication rate between SADI-S and double-anastomosis DS at a single institution.Setting
Academic hospital, United States.Methods
A retrospective chart review was performed on 185 patients who underwent laparoscopic or robot-assisted laparoscopic DS between March 1, 2015 and December 10, 2017. A total of 111 patients had SADI-S, and 74 patients underwent double-anastomosis DS.Results
Baseline patient characteristics were comparable between the 2 groups. The mean preoperative body mass index was 56.3 kg/m2 and 54.4 kg/m2 in SADI-S and double-anastomosis DS patients, respectively. Thirteen (11.7%) and 4 (5.4%) patients were readmitted within 30 days after SADI-S and double-anastomosis DS, respectively (P?=?.16). Percentage of total weight loss was 22.0%, 38.5%, and 44.2% in the SADI-S group and 20.2%, 38.0%, and 48.4% in the double-anastomosis DS group at 6, 12, and 24 months, respectively. The majority of patients had vitamin A and E levels in the normal range. However, 40% to 60% of the patients had low levels of vitamin D after the procedure.Conclusions
SADI-S and double-anastomosis DS are comparable in terms of weight loss and complication rate. However, close nutritional follow-up is warranted for both procedures. 相似文献5.
Steven D. Glassman Leah Y. Carreon Morgan E. Brown Jeffrey S. Jones Jean Edward Jing Li Mark V. Williams 《The spine journal》2019,19(4):711-716
BACKGROUND CONTEXT
Health literacy, defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,” has been demonstrated to affect access to care and appropriate healthcare utilization.PURPOSE
To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain.STUDY DESIGN
Cross sectional.PATIENT SAMPLE
Patients seen at a multisurgeon spine specialty clinic.OUTCOME MEASURES
Oswestry Disability Index, EQ-5D, and Numeric Rating Scales (0–10) for back and leg pain.METHODS
The Newest Vital Sign (NVS) and Health Literacy Survey, Oswestry Disability Index, EQ-5D and pain scales were administered to patients undergoing evaluation and treatment for lumbar degenerative disease in the outpatient setting. Patients were surveyed regarding their use of medication, therapy, and pain management modalities.RESULTS
Of 201 patients approached for participation, 186 completed the health literacy surveys. Thirty (17%) were assessed as having limited literacy, 52 (28%) as possibly having limited literacy and 104 (56%) having adequate literacy based on their NVS scores. The cohort with low NVS scores also had low Health Literacy Survey Scores. Patients with limited literacy had worse back and leg pain scores compared with patients with possibly limited literacy and adequate literacy. Patients with adequate health literacy were more likely to use medications (80% vs. 53%, p?=?.017) and were more likely to see a specialist (34% vs. 17%) compared with those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more visits (19 vs. 8).CONCLUSIONS
Patients with lower health literacy reported worse back and leg pain scores, indicating either more severe disease or a fundamental difference in their responses to standard health-related quality of life measures. This study also suggests that patients with limited health literacy may underutilize some resources and overutilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes. 相似文献6.
Saurav Chakravartty Gillian Vivian Nicola Mullholland Hizbullah Shaikh John McGrath Paul S. Sidhu Ounali Jaffer Ameet G. Patel 《Surgery for obesity and related diseases》2019,15(1):117-125
Background
In bariatric surgery, preoperative very low-calorie diets (VLCD) may better meet the technical demands of surgery by shrinking the liver. However, diets may affect tissue healing and influence bowel anastomosis in an as-yet-undefined manner.Objective
This randomized controlled trial aimed to examine the effect on collagen deposition in wounds in patients on a 4-week VLCD before laparoscopic gastric bypass.Setting
University hospital.Methods
The trial was undertaken in patients undergoing laparoscopic Roux-en-Y gastric bypass, with a control group (n?=?10) on normal diet and an intervention group (n?=?10) on VLCD (800 kcal) for 4 weeks. The primary outcome measured was expression of collagen I and III in skin wounds, with biopsies taken before and after the diet and 7 days postoperatively as a surrogate of anastomotic healing. Secondary outcome measures included liver volume and fibrosis score, body composition, operating time, blood loss, hospital stay, and complications.Results
Patients in both groups were similar in age, sex, body mass index (53.4 versus 52.8 kg/m2), co-morbidities, liver volume, and body composition. Expression of mature collagen type I was significantly decreased in diet patients compared with controls after 4 weeks of diet and 7 days after surgery. This was significant decrease in liver volume (23% versus 2%, P?=?.03) but no difference in operating times (129 versus 139 min, P?=?.16), blood loss, length of stay, or incidence of complications.Conclusions
Preoperative diets shrink liver volume and decrease expression of mature collagen in wounds after surgery. Whether the latter has a detrimental effect on clinical outcomes requires further evaluation. 相似文献7.
Alisson R. Teles Don Daniel Ocay Abdulaziz Bin Shebreen Andrew Tice Neil Saran Jean A. Ouellet Catherine E. Ferland 《The spine journal》2019,19(4):677-686
BACKGROUND CONTEXT
Although 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms.PURPOSE
To identify the presence of sensitization in nociceptive pathways and to assess the efficacy of the diffuse noxious inhibitory control in patients with AIS presenting with chronic back pain.STUDY DESIGN
Cross-sectional study.PATIENT SAMPLE
Ninety-four patients diagnosed with AIS and chronic back pain.OUTCOME MEASURES
Quantitative sensory testing (QST) assessed pain modulation and self-reported questionnaires were used to assess pain burden and health-related quality of life.METHODS
Patients underwent a detailed pain assessment using a standard and validated quantitative sensory testing (QST) protocol. The measurements included mechanical detection thresholds (MDT), pain pressure threshold (PPT), heat pain threshold (HPT), heat tolerance threshold (HTT), and a conditioned pain modulation (CPM) paradigm. Altogether, these tests measured changes in regulation of the neurophysiology underlying the nociceptive processes based on the patient's pain perception. Funding was provided by The Louise and Alan Edwards Foundation and The Shriners Hospitals for Children.RESULTS
Efficient pain inhibitory response was observed in 51.1% of patients, while 21.3% and 27.7% had sub-optimal and inefficient CPM, respectively. Temporal summation of pain was observed in 11.7% of patients. Significant correlations were observed between deformity severity and pain pressure thresholds (p=.023) and CPM (p=.017), neuropathic pain scores and pain pressure thresholds (p=.015) and temporal summation of pain (p=.047), and heat temperature threshold and pain intensity (p=.048).CONCLUSIONS
Chronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome. 相似文献8.
Peter William Lundberg Jill Stoltzfus Maher El Chaar 《Surgery for obesity and related diseases》2019,15(1):1-7
Background
Sleeve gastrectomy (SG) is the most popular bariatric procedure in the United States. Although standardized, variation exists in how the staple line is managed. Robotic approaches to SG (RSG) are increasing, though benefits compared with the conventional laparoscopic approach (LSG) remain controversial.Objective
Evaluate the safety of RSG versus LSG using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry, controlling for variation in staple-line management.Setting
University health network, United States.Methods
SG cases from January 1 to December 31, 2016, in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry were included. Demographic characteristics and 30-day outcomes were analyzed with separate Mann-Whitney rank sums tests, χ2 tests, or Fisher's exact tests, with P < .05 denoting statistical significance. Multivariate regression analysis was performed to control for method of staple-line treatment.Results
Of the 107,726 patients who underwent SG, 7385 were RSG. Treatment of the staple line was associated with a significantly lower rate of bleeding, with odds ratios of .69 and .58 for staple-line reinforcement alone and staple-line reinforcement plus oversewing, respectively. Multivariate analysis revealed RSG had a higher rate of organ space infection than LSG (odds ratio 2.07). Otherwise, RSG did not significantly differ from LSG save for a longer median operative time (89 versus 63 min, respectively, P < .0001).Conclusions
RSG is a growing alternative to the conventional laparoscopic approach. According to the 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, the RSG carries a higher risk of organ space infection. The reasons behind this finding require further study. 相似文献9.
Konstantinos Arapis Nicoletta Macrina Diana Kadouch Lara Ribeiro Parenti Jean Pierrre Marmuse Boris Hansel 《Surgery for obesity and related diseases》2019,15(1):23-33
Background
Among the population of morbidly obese people, super-super-obese (SSO) individuals (body mass index >60 kg/m2) present a treatment challenge for bariatric surgeons.Objectives
To compare the long-term outcomes between laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) and to evaluate the efficacy of SG as a stand-alone bariatric procedure for SSO patients.Setting
University hospital, Paris, France.Methods
We retrospectively reviewed the data outcomes of 210 SSO patients who underwent SG or RYGB between January 2000 and December 2011. The 6-year follow-up data were analyzed and compared.Results
Follow-up data at 6 years were collected for 57.1% and 52.1% of patients in the SG group and RYGB groups, respectively. Both procedures were effective at promoting weight loss. Most weight loss was achieved at 24 months with both procedures. The average percent excess weight loss and change in body mass index of SG versus RYGB showed no significant differences at the 4-year follow-up. Except for sleep apnea, RYGB showed slightly better resolution of the evaluated co-morbidities. The composite endpoint of major short-term adverse events (<30 d) occurred in 11.7% of patients with RYGB and 6.4% of those with SG (P?=?.02). Postoperative complications were seen in 26% of RYGB patients and 16.1% of SG patients.Conclusions
SG as a primary procedure for SSO patients remains effective even though RYGB achieves better midterm outcomes. SG can be proposed as the primary-option p+rocedure. Further investigations are needed to identify the ideal procedure for patients with symptoms of gastroesophageal reflux disease. 相似文献10.
Alexander Tuchman Lawrence G. Lenke Meghan Cerpa Michael G. Fehlings Stephen J. Lewis Christopher I. Shaffrey Kenneth M.C. Cheung Leah Yacat Carreon Mark B. Dekutoski Frank J. Schwab Oheneba Boachie-Adjei Khaled Kebaish Christopher P. Ames Yong Qiu Yukihiro Matsuyama Benny T. Dahl Hossein Mehdian Ferran Pellisé Sigurd H. Berven 《The spine journal》2019,19(3):395-402
BACKGROUND CONTEXT
Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long-term recovery has not been previously studied in this population.PURPOSE
To evaluate whether bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits.STUDY DESIGN
Secondary analysis of a prospective, multicenter, international cohort study.METHODS
In a cohort of 272 patients, neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed.RESULTS
A total of 265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR] 47.5–50.0; bilateral 50.0, IQR 48.0–50.0, p=.939) or change in LEMS from baseline (unilateral 0.0, IQR ?1.0 to 0.0; bilateral 0.0, IQR ?1.0 to 0.0, p=.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by 2 years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7±0.6 versus 3.2±0.6 (p=.009) for unilateral and bilateral groups, respectively.CONCLUSIONS
The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weaknesses. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery. 相似文献11.
Carolyn E. Schwartz Jie Zhang Bruce D. Rapkin Joel A. Finkelstein 《The spine journal》2019,19(4):726-734
Background Context
Underlying cognitive factors have been found to influence patients’ symptom experience. Current evidence suggests that concomitant changes in appraisal must be taken into account to accurately interpret change as measured by standard spine patient-reported outcomes (PROs).Purpose
To investigate changes in patients’ minimally important differences (MID) over recovery from spinal surgery; whether and how cognitive appraisal processes are implicated in the change trajectories.Study Design/Setting
Longitudinal cohort study with up to 12 months follow-up.Patient Sample
Surgical patients (n?=?167) with a diagnosis of disc herniation or spinal stenosis.Outcome Measures
Standard spine patient-reported PROs were used (Rand-36, Oswestry Disability Index, Numerical Rating Scale for pain, PROMIS Pain Impact).Methods
This study was funded by the Feldberg Chair in Spinal Research, Sunnybrook Health Sciences Centre and the authors have no conflicts of interest. MID used an anchor technique and was computed by global assessment of change (GAC) grouping. Participants were binned into groups based on their GAC response patterns at all time points: Consistently better post-surgery, consistently worse post-surgery, and bouncers, whose GAC ratings fluctuate (ie, better-then-worse-then-better; or vice versa). Individuals’ longitudinal quality of life (QOL) and appraisal slope scores were computed. QOL-appraisal slopes’ correlations were computed by GAC group. Fisher's Z transformation tested the hypothesis that GAC groups differed in the QOL-appraisal relationship over time.Results
Moderate to large changes are recognized as clinically important in the early stages of recovery (ie, 6 weeks post-surgery), and over time smaller and smaller changes become important. The three pattern groups emphasized and deemphasized different standards of comparison over time, with the Better group emphasizing personal goals and the Worse and Bouncers deemphasizing doctors’ input. These group differences translated to differential relationships between PRO change and appraisal changes over time.Conclusions
The MID reflects increasingly subtle change over time in PROs. Appraisal may influence how patients experience the same (MID) change over time, with better outcomes associated with emphasizing long-term goals. PRO change seems to be driven by different standards of comparison. Potential avenues for clinical intervention are discussed. 相似文献12.
José Miguel Spirig Reto Sutter Tobias Götschi Nadja A. Farshad-Amacker Mazda Farshad 《The spine journal》2019,19(3):461-468
BACKGROUND CONTEXT
Pedicle screw loosening is common after spinal fusion and can be associated with pseudoarthrosis and pain. With suspicion of screw loosening on standard radiographs, CT is currently considered the advanced imaging modality of choice. MRI with new metal artifact reduction techniques holds potential to be sensitive in detection of screw loosening. The sensitivity and specificity of either of the imaging modalities are yet clear.PURPOSE
To evaluate the sensitivity and specificity of three different image modalities (standard radiographs, CT, and MRI) for detection of pedicle screw loosening.STUDY DESIGN/SETTING
Cross-sectional diagnostic study.PATIENT SAMPLE
Forty-one patients (159 pedicle screws) undergoing revision surgeries after lumbar spinal fusion between August 2014 and April 2017 with preoperative radiographs, CT, and MRI with spinal metal artifact reduction (STIR WARP and TSE high bandwidth sequences).OUTCOME MEASURES
Sensitivity and specificity in detection of screw loosening for each imaging modality.METHODS
Screw torque force was measured intraoperatively and compared with preoperative screw loosening signs such as peri-screw edema in MRI and peri-screw osteolysis in CT and radiographs. A torque force of less than 60 Ncm was used to define a screw as loosened.RESULTS
Sensitivity and specificity in detection of screw loosening was 43.9% and 92.1% for MRI, 64.8% and 96.7% for CT, and 54.2% and 83.5% for standard radiographs, respectively.CONCLUSIONS
Despite improvement of MRI with metal artifact reduction MRI technique, CT remains the modality of choice. Even so, CT fails to detect all loosened pedicle screws. 相似文献13.
Background
The aim of this study was to identify the risk factors for structural recurrence with a focus on lymph node–related factors and to determine the optimal cutoff size of lymph node micrometastases in patients with pathologic N1a classical papillary thyroid carcinoma.Methods
We included patients who underwent total thyroidectomy with central compartment lymph node dissection for classic papillary thyroid carcinoma with pathologic N1a classification.Results
A total of 398 patients were followed up for a median of 131 months. Structural recurrence occurred in 17.3% of patients (69/398). The multivariate analysis reported the following independent risk factors for structural recurrence: tumor size >1.95 cm, bilaterality, lymphatic and/or vascular invasion, a maximum diameter of the metastatic lymph node focus >3.5 mm, distribution of metastatic lymph node foci size >3.0 mm, and ≥4 metastatic lymph nodes.Conclusion
The newly proposed cutoff of 3.5 mm for a definition of lymph node micrometastasis in pathologic N1a papillary thyroid carcinoma patients can reclassify the risk estimates of structural recurrence, thus modifying postoperative management plans and follow-up strategies. 相似文献14.
Imad S Nahle Hubert Labelle Stefan Parent Julie Joncas Jean-Marc Mac-Thiong 《The spine journal》2019,19(4):670-676
BACKGOUND CONTEXT
Abnormal proximal femoral angle (PFA) was recently found to be associated with deteriorating sagittal balance and quality of life (QoL) in high-grade spondylolisthesis (HGS). However, the influence of PFA on the QoL of patients undergoing surgery remains unknown.PURPOSE
This study compares the pre- and postoperative measurements of sagittal balance including PFA in patients with lumbosacral HGS after surgery. It also determines if PFA is a radiographic parameter that is associated with QoL in patients undergoing surgery.STUDY DESIGN
Retrospective cohort study.PATIENT SAMPLE
Thirty-three patients (mean age 15.6 ± 3.0 years) operated for L5-S1 HGS between July 2002 and April 2015. Thirteen had in situ fusion and 20 had reduction to a low-grade slip.OUTCOME MEASURES
The outcome measures included PFA and QoL scores measured from the Scoliosis Research Society SRS-30 QoL questionnaire.METHODS
The minimum follow-up was 2 years. PFA and QoL were compared pre- and postoperatively. Statistical analysis used nonparametric Mann-Whitney and Wilcoxon Signed Rank tests, Chi-square tests to compare proportions, and bivariate correlations with Spearman's coefficients.RESULTS
A decreasing PFA correlated with less pain (r = ?0.56, p?=?.010), improved function (r = ?0.51, p?=?.022) and better self-image (r = ?0.46, p?=?.044) postreduction. Reduction decreased PFA by 5.1° (p?=?.002), whereas in situ fusion did not alter PFA significantly. Patients with normal preoperative PFA had similar postoperative QoL regardless of the type of surgery, except for self-image, which improved further with reduction (3.73 ± 0.49 to 4.26 ± 0.58, p?=?.015). Patients with abnormal preoperative PFA tended to have a higher QoL in all domains after reduction.CONCLUSION
Decreasing PFA correlates with less pain, better function and self-image. Reduction of HGS decreases PFA. Reduction also relates to a better postoperative QoL when the preoperative PFA is abnormal. When the preoperative PFA is normal, in situ fusion is equivalent to reduction except for self-image, which is better improved after reduction. 相似文献15.
Nadia A. Henriksen Haytham Al-Tayar Jacob Rosenberg Lars Nannestad Jorgensen 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2012,16(3):353-359
Background and Objectives:
Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed as conventional laparoscopic 4-port cholecystectomy or as single-incision laparoscopic cholecystectomy.Methods:
Two consecutive series of patients undergoing single-incision laparoscopic cholecystectomy were assessed: (1) single-incision cholecystectomy using a commercially available multichannel port (n=80) and (2) a modified single-incision cholecystectomy using 2 regular trocars inserted through the umbilicus (n=20) with transabdominal sutures for gallbladder mobilization (puppeteering technique). Patients who underwent conventional 4-port cholecystectomy during the same time period (n=100) were selected as controls.Results:
The instrumental cost of the single-incision cholecystectomy using a commercial port was significantly higher (median, $1123) than the cost for conventional 4-port (median $441, P < .0005) and modified single-incision cholecystectomy (median $342, P < .0005). The cost of the modified single-incision procedure was significantly lower than that for the 4-port cholecystectomy (P < .0005).Conclusion:
The modified single-incision procedure using 2 regular ports inserted through the umbilicus can be performed at lower cost than conventional 4-port cholecystectomy. 相似文献16.
Ivy N. Haskins Lisbi Rivas Tammy Ju Ashlyn E. Whitlock Richard L. Amdur Anton N. Sidawy Paul P. Lin Khashayar Vaziri 《Surgery for obesity and related diseases》2019,15(1):109-115
Background
Venous thromboembolism, including pulmonary embolism (PE) and deep venous thrombosis, is a leading cause of morbidity and mortality after bariatric surgery. Inferior vena cava filters (IVCFs) have been used as a method to reduce the incidence of clinically significant PEs after bariatric surgery.Objectives
To compare the incidence of postoperative PEs in patients with IVCFs with those in patients without IVCFs at the time of bariatric surgery.Setting
American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.Methods
All patients undergoing laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy from 2015 to 2016 were identified within the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Patients with an IVCF present at the time of surgery were compared with those patients without an IVCF present at the time of surgery with respect to preoperative patient variables, operative variables, incidence of 30-day PE, deep venous thrombosis, and additional 30-day morbidity and mortality.Results
A total of 286,704 patients met the inclusion criteria; 2512 (.9%) patients had an IVCF present at the time of surgical intervention, of which 1747 (69.5%) were placed within 30 days of bariatric surgery. Patients with an IVCF were higher-risk patients as determined by previously established risk factors for venous thromboembolism events. When a subgroup matched analysis using variables associated with the risk of venous thromboembolism events was performed looking at higher-risk patients only, there was no statistically significant difference in the incidence of PE based on the presence of an IVCF.Conclusion
IVCFs are being selectively placed in higher-risk patients. Despite their selective use, IVCFs do not appear to have a protective benefit with respect to the incidence of postoperative PE events. 相似文献17.
Akira Miyauchi Takumi Kudo Yasuhiro Ito Hitomi Oda Masatoshi Yamamoto Hisanori Sasai Takuya Higashiyama Hiroo Masuoka Mitsuhiro Fukushima Minoru Kihara Akihiro Miya 《Surgery》2019,165(1):25-30
Background
We report on the growth of papillary microcarcinoma during active surveillance and before clinical presentation.Methods
We conducted a retrospective study of 169 patients with papillary microcarcinoma who were enrolled in active surveillance at our hospital between 2000 and 2004. Patients were followed for a median of 10.1 years using serial ultrasonography (median, 12 examinations), used to calculate the tumor doubling time. To contextualize tumor growth rates during active surveillance, we calculated the hypothetical tumor doubling time before clinical presentation. To resolve the limitations in tumor doubling time, tumor doubling rates were inversely transformed into doubling rates.Results
The doubling rates (per year) during active surveillance (median: 0.0) were >0.5, 0.1 to 0.5, ?0.1 to 0.1, and <?0.1 in 5, 38, 97, and 29 cases, respectively. The proportions of tumors with rather rapid growth, slow growth, stable, and a decrease in size were 3%, 22%, 57%, and 17%, respectively.Conclusion
Tumor growth of papillary microcarcinomas varies from rather rapid growth to a decrease in size during active surveillance. 相似文献18.
David Gutierrez Blanco David Romero Funes Giulio Giambartolomei Emanuele Lo Menzo Samuel Szomstein Raul J. Rosenthal 《Surgery for obesity and related diseases》2019,15(1):14-20
Background
There is a paucity of studies comparing risk reduction of the atherosclerotic cardiovascular disease (ASCVD) and Framingham-body mass index (BMI) Coronary Heart risk score after a laparoscopic Roux-en-Y gastric bypass (RYGB), and few studies have assessed the efficacy of laparoscopic sleeve gastrectomy (SG) in reducing cardiovascular risk.Objective
Our goal in this study was to compare the impact of SG and RYGB on cardiovascular risk reduction.Setting
U.S. university hospital.Methods
We retrospectively reviewed the records of all SG or RYGB cases at our institution between 2010 and 2015. Patients who met the criteria for calculating the ASCVD 10-year and Framingham-BMI score were included in the study. Propensity score matching was used to match SG and RYGB on demographic characteristics and co-morbidities.Results
Of the 1330 bariatric patients reviewed in the study period, 219 (19.3%) patients met the criteria for risk score calculation. SG was the most prevalent surgery in 72.6% (N?=?159) of cases compared with RYGB in 27.4% (N?=?60) of cases. At 12-month follow-up, ASCVD 10-year score had an absolute risk reduction of 3.9 ± 6.5% in SG patients and 2.9 ± 5.8% in RYGB patients (P?=?.3). Framingham-BMI score absolute risk reduction was 11.0 ± 12.0% in SG and 9.0 ± 11.0% in RYGB patients (P?=?.4), and the decrease in estimated heart age was 12.1 ± 15.6 years in SG versus 9.2 ± 9.6 years in RYGB (P?=?.1). The percentage of estimated BMI loss at 1 year was 68.1 ± 23.3% in SG versus 74.2 ± 24.8% in RYGB (P?=?.1).Conclusion
Our results suggest that SG and RYGB are equally effective in improving cardiovascular risk and decreasing the estimated vascular/heart age at 12-month follow-up. 相似文献19.
Shinichi Ishihara Nobuyuki Fujita Koichiro Azuma Takehiro Michikawa Mitsuru Yagi Takashi Tsuji Michiyo Takayama Hideo Matsumoto Masaya Nakamura Morio Matsumoto Kota Watanabe 《The spine journal》2019,19(3):493-500
BACKGROUND CONTEXT
Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted.PURPOSE
To elucidate potential association between SEL and metabolic syndrome.STUDY DESIGN
An observational study used data of a medical checkup.PATIENT SAMPLE
We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study.OUTCOME MEASURES
The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated.METHODS
The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated.RESULTS
The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5–9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm2 (OR=4.8, 95% CI=1.5–15.3) and hypertension (OR=3.5, 95% CI=1.1–11.8) were observed to be independently associated with SEL.CONCLUSION
This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome. 相似文献20.
