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Medicine Mar 2018The incidence of tumors located in the upper third of the stomach is increasing, and the use of radical proximal gastrectomy is becoming prevalent. After a proximal... (Review)
Review
BACKGROUND
The incidence of tumors located in the upper third of the stomach is increasing, and the use of radical proximal gastrectomy is becoming prevalent. After a proximal gastrectomy, various reconstructions are performed, but surgical outcomes are controversial. This study was performed to review clinical outcomes of reconstructions after proximal gastrectomy.
METHODS
Inclusion criteria focused on postoperative complications of patients who underwent a proximal gastrectomy for gastric cancer. Exclusion criteria were case reports; targeted data not investigated; a duplicate study reported in a larger cohort; esophageal sphincter preservation surgery; near-total gastrectomy; recurrence of tumor; and combined organ resection.
RESULTS
In total, 22 retrospective and 2 prospective studies were included. The studies investigated surgical outcomes of esophagogastrostomy (n = 10), jejunal interposition (n = 12), jejunal pouch interposition (n = 7), double tract jejunal interposition (n = 1), and tube-like stomach esophagogastrostomy (n = 5). Pooled incidences of reflux esophagitis or reflux symptoms for these procedures were 28.6%, 4.5%, 12.9%, 4.7%, and 10.7%, respectively. Incidences of postoperative complications were 9.5%, 18.1%, 7.0%, 11.6%, and 9.3%, respectively.
CONCLUSIONS
Despite increasing operation complexity, which perhaps increased the risk of other postoperative complications, currently used reconstructions present excellent anti-reflux efficacy. However, the optimal reconstruction method remains to be determined.
Topics: Gastrectomy; Gastric Stump; Gastroesophageal Reflux; Humans; Postoperative Complications; Stomach Neoplasms; Treatment Outcome
PubMed: 29538208
DOI: 10.1097/MD.0000000000010121 -
Cancer Causes & Control : CCC Oct 2021Evidence of differences in the etiology of, and poorer survival from, proximal colon compared to the distal colorectum, necessitates research into its risk factors. This... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Evidence of differences in the etiology of, and poorer survival from, proximal colon compared to the distal colorectum, necessitates research into its risk factors. This systematic review summarizes the evidence on medication use and proximal colon cancer risk.
METHODS
MEDLINE and EMBASE were searched for prospective studies investigating nine medication groups, namely non-steroidal anti-inflammatory drugs (NSAIDs), exogenous hormones, i.e., hormone replacement therapy (HRT) or oral contraceptives (OCs), statins, proton pump inhibitors, anti-hypertensives, metformin (an antidiabetic), antidiarrheals or laxatives, and the risk of proximal colon cancer. Narrative synthesis and meta-analyses, using random effects models to estimate risk ratios (RRs) and 95% confidence intervals (CIs), were conducted.
RESULTS
Twenty nine publications investigating NSAIDs (n = 13), exogenous hormones [HRT (n = 9) or OCs (n = 4)] statins (n = 5), anti-hypertensives (n = 1), and metformin (n = 1) were included. Summary RRs reported a protective effect of aspirin use (RR 0.80, 95% CI 0.73-0.89) but no associations between HRT (RR 0.92, 95% CI 0.83-1.02), OC (RR 1.06, 95% CI 0.98-1.14) or statin use (RR 0.94, 95% CI 0.67-1.31), and proximal colon cancer incidence compared to never/non-use. One study on metformin and one on anti-hypertensives reported no association. Sources of between-study heterogeneity included study design, period of exposure ascertainment, exposure source, and exposure comparison, but this exploration was hindered by the small numbers of studies.
CONCLUSION
Despite some studies on NSAID or HRT use, evidence on the impact of a range of medications on proximal colon cancer risk is limited. This highlights the need for more research to inform chemoprevention strategies.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Colonic Neoplasms; Humans; Prospective Studies; Risk Factors
PubMed: 34224060
DOI: 10.1007/s10552-021-01472-8 -
Journal of Shoulder and Elbow Surgery Oct 2022The treatment of proximal humerus fracture dislocations can be challenging given the extensive injury to the proximal humeral anatomy and increased risk of... (Review)
Review
BACKGROUND
The treatment of proximal humerus fracture dislocations can be challenging given the extensive injury to the proximal humeral anatomy and increased risk of devascularization of the humeral head often seen in these injuries. The purpose of this study is to undertake a systematic review of the literature on the functional outcomes, rate of revision, and short- and long-term complications for proximal humerus fracture dislocations treated with open reduction and internal fixation (ORIF).
METHODS
The PubMed and OVID Embase databases were queried for literature reporting on proximal humerus fracture dislocations treated with ORIF. Data including study design, patient demographics, functional outcomes, and complications were recorded.
RESULTS
Twelve studies including 294 patients with Neer type 2-, 3-, or 4-part proximal humerus fracture dislocations met the criteria for inclusion. The mean patient age was 53.4 years (19-89 years) with an average follow-up of 2.9 years (1.15-4.9 years). At the final follow-up, the mean Constant score was 73.2 (52-87.3) and the mean Disabilities of the Arm Shoulder and Hand score was 26.6 (17.5-32). Avascular necrosis was observed in 20.0% (0%-82.3%) and nonunion was observed in 3.0% (0%-7.7%) of patients. Conversion to arthroplasty was observed in 10.7% (5%-20%) and a total reoperation was observed in 35.6% (11.8%-89.1%) of patients in studies explicitly reporting these outcomes. In addition to conversion to arthroplasty, common causes of reoperation were revision ORIF (5.2%) and hardware removal (22.2%).
CONCLUSION
Patients undergoing ORIF for proximal humerus fracture dislocations have reasonable functional outcomes but relatively high avascular necrosis and reoperation rates. This information can be used to counsel patients and set expectations about the potential for further surgeries.
Topics: Fracture Dislocation; Fracture Fixation, Internal; Humans; Humerus; Joint Dislocations; Middle Aged; Necrosis; Shoulder; Shoulder Fractures; Treatment Outcome
PubMed: 35605847
DOI: 10.1016/j.jse.2022.04.018 -
Community Dentistry and Oral... Jun 2021To perform a systematic review and meta-analysis of the performance of different methods for detecting carious lesions in permanent and primary teeth, considering all... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review and meta-analysis of the performance of different methods for detecting carious lesions in permanent and primary teeth, considering all types of tooth surface.
METHODS
Two reviewers searched PubMed, Embase, Scopus and other sources up to November 2020 to identify published and nonpublished studies in English. We focused on three caries detection methods: visual inspection (VI), radiographic (RX) and fluorescence-based (LF). We included studies investigating at least one of these methods which (a) assessed the accuracy of the method in detecting caries lesions; (b) considered occlusal, proximal or free smooth surfaces in primary or permanent teeth; (c) used a reference standard other than one of the three methods; and (d) reported data on sample size and accuracy. Multilevel analyses, meta-regressions and comparisons of bivariate summary receiver operating characteristics curves were undertaken.
RESULTS
Two hundred and forty manuscripts from 14 129 articles initially identified met the inclusion criteria. VI was better than RX on occlusal surfaces at all caries lesion thresholds and proximal surfaces of permanent teeth only at all lesion thresholds in laboratory setting. LF was slightly better than VI for advanced lesions on occlusal surfaces of permanent teeth in the clinical setting and for all lesions on proximal surfaces of permanent teeth in the laboratory setting. Still, LF was worse than VI for advanced occlusal lesions in permanent teeth in the laboratory setting. Although LF showed slightly better performance than VI with advanced lesions, the latter had significantly higher specificity than other methods in all settings.
CONCLUSION
Visual caries detection alone is adequate for most patients in daily clinical practice regardless of tooth type or surface.
Topics: Dental Caries; Dental Caries Susceptibility; Dentition, Permanent; Humans; ROC Curve; Sensitivity and Specificity; Tooth, Deciduous
PubMed: 33847007
DOI: 10.1111/cdoe.12641 -
Surgery Aug 2023The role of proximal diversion in patients undergoing sigmoid resection and primary anastomosis for diverticulitis with generalized peritonitis is unclear. The aim of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The role of proximal diversion in patients undergoing sigmoid resection and primary anastomosis for diverticulitis with generalized peritonitis is unclear. The aim of this study was to compare the clinical outcomes of sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with a proximal diversion in perforated diverticulitis with diffuse peritonitis.
METHOD
A systematic literature search on sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with proximal diversion for diverticulitis with diffuse peritonitis was conducted in the Medline and EMBASE databases. Randomized clinical trials and observational studies reporting the primary outcome of interest (30-day mortality) were included. Secondary outcomes were major morbidity, anastomotic leak, reoperation, stoma nonreversal rates, and length of hospital stay. A meta-analysis of proportions and linear regression models were used to assess the effect of each procedure on the different outcomes.
RESULTS
A total of 17 studies involving 544 patients (sigmoid resection and primary anastomosis: 287 versus sigmoid resection and primary anastomosis with proximal diversion: 257) were included. Thirty-day mortality (odds ratio 1.12, 95% confidence interval 0.53-2.40, P = .76), major morbidity (odds ratio 1.40, 95% confidence interval 0.80-2.44, P = .24), anastomotic leak (odds ratio 0.34, 95% confidence interval 0.099-1.20, P = .10), reoperation (odds ratio 0.49, 95% confidence interval 0.17-1.46, P = .20), and length of stay (sigmoid resection and primary anastomosis: 12.1 vs resection and primary anastomosis with diverting ileostomy: 15 days, P = .44) were similar between groups. The risk of definitive stoma was significantly lower after sigmoid resection and primary anastomosis (odds ratio 0.05, 95% confidence interval 0.006-0.35, P = .003).
CONCLUSION
Sigmoid resection and primary anastomosis with or without proximal diversion have similar postoperative outcomes in selected patients with diverticulitis and diffuse peritonitis. However, further randomized controlled trials are needed to confirm these results.
Topics: Humans; Diverticulitis, Colonic; Anastomotic Leak; Colostomy; Intestinal Perforation; Diverticulitis; Anastomosis, Surgical; Peritonitis; Treatment Outcome
PubMed: 37258308
DOI: 10.1016/j.surg.2023.04.035 -
Annals of Medicine Aug 2014While collagenous colitis represents the most common form of the collagenous gastroenteritides, the collagenous entities affecting the proximal part of the... (Review)
Review
AIM
While collagenous colitis represents the most common form of the collagenous gastroenteritides, the collagenous entities affecting the proximal part of the gastrointestinal tract are much less recognized and possibly overlooked. The aim was to summarize the latest information through a systematic review of collagenous gastritis, collagenous sprue, and a combination thereof.
METHOD
The search yielded 117 studies which were suitable for inclusion in the systematic review. Excluding repeated cases, 89 case reports and 28 case series were reported, whereas no prospective studies with or without control groups were identified. Further, no randomized, controlled trials were identified. The total number of patients with proximal collagenous gastroenteritides reported was 330.
RESULTS
An overview of clinical presentations, prognosis, pathophysiology and histopathology, as well as management of these disorders is presented. The prognosis of both collagenous gastritis and sprue seems not to be as dismal as considered previously. Data point to involvement of immune or autoimmune mechanisms potentially driven by luminal antigens initiating the fibroinflammatory condition.
CONCLUSIONS
To reach the diagnosis it is recommended that biopsies are obtained during gastroduodenoscopies. Therapies with anti-secretory strategies, glucocorticoids, and in some cases iron supplementation are suggested, although rational treatment options from randomized, controlled trials do not exist for these rare or even overlooked disorders.
Topics: Biopsy; Colitis, Collagenous; Collagen; Collagenous Sprue; Endoscopy, Gastrointestinal; Gastritis; Gastroenteritis; Glucocorticoids; Humans; Iron Compounds; Prognosis
PubMed: 24716737
DOI: 10.3109/07853890.2014.899102 -
The Journal of Prosthetic Dentistry Mar 2023Proximal contact loss between implant-supported prostheses and adjacent natural teeth is a complication that has been reported in clinical practice. However, the... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Proximal contact loss between implant-supported prostheses and adjacent natural teeth is a complication that has been reported in clinical practice. However, the prevalence of the condition is unclear.
PURPOSE
The purpose of this systematic review and meta-analysis was to assess the proportion of reported proximal contact loss between implant-supported prostheses and adjacent natural teeth.
MATERIAL AND METHODS
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology criteria and was registered on the international prospective register of systematic reviews (PROSPERO) platform (CRD42021225138). The electronic search was conducted by using the PubMed/MEDLINE, Embase, and Cochrane Library databases to September 2020. The formulated population, intervention, comparison, outcome (PICO) question was "Is there a correlation of the proximal contact loss between implant-supported prostheses and the adjacent natural tooth?" A single-arm meta-analysis of proportion was performed to evaluate the cumulative prevalence of survival and complication rates.
RESULTS
This review included 10 studies, half of which presented proximal contact loss rates higher than 50%. In the general analysis, the open proximal contact showed a cumulative proportion of 41% (confidence interval: 30% to 53%; heterogeneity: I=98%; t=0.578; P<.01). From the subanalysis, the mesial contact (47%; confidence interval: 32% to 62%; heterogeneity: I= 96%; t=0.657; P<.01) and the mandibular arch (41%; confidence interval: 30% to 52%; heterogeneity: I=92%; t=0.302; P<.01) were found to have higher prevalence.
CONCLUSIONS
The prevalence of proximal contact loss was high, occurring more frequently with the mesial contact and in the mandibular arch. Significant differences were not found in relation to sex or between the posterior and anterior regions.
Topics: Humans; Dental Implants; Prevalence; Dental Prosthesis, Implant-Supported; Mouth, Edentulous; Databases, Factual
PubMed: 34294422
DOI: 10.1016/j.prosdent.2021.05.025 -
Orthopaedic Journal of Sports Medicine May 2021Patient-reported outcome measures are important to determine outcomes after orthopaedic procedures. There is currently no standard for outcome measures in the evaluation... (Review)
Review
BACKGROUND
Patient-reported outcome measures are important to determine outcomes after orthopaedic procedures. There is currently no standard for outcome measures in the evaluation of patient outcomes after proximal hamstring repair.
PURPOSE
To identify and evaluate outcome measures used after proximal hamstring repair.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review was performed to identify all English-language articles assessing outcomes after proximal hamstring repair in PubMed, Embase, CINAHL via EBSCOhost, MEDLINE via OvidSP, and Web of Science between 2000 and 2019. After duplicates were removed, studies were selected using eligibility criteria established by the authors. Image reviews, anatomic/histology studies, literature reviews, surgical technique reports, systematic reviews, narrative reviews, case studies, and studies with <5 patients were excluded. Extraction, synthesis, and analysis of outcome measure data were performed using Microsoft Excel. Quality assessment of included studies was performed using Methodological Index for Non-Randomized Studies criteria.
RESULTS
After duplicate articles were removed, a total of 304 unique articles were identified and 27 met the inclusion criteria. The mean number of patients with proximal hamstring repairs per study was 40. The most frequently reported outcome measures were return to sport (14/27; 51.9%), custom survey/questionnaire (13/27; 48.1%), and isokinetic hamstring strength testing (13/27; 48.1%). Six of the 10 most commonly used outcome measures were validated and included Lower Extremity Functional Scale, 12-Item Short Form Health Survey, visual analog scale for pain, Perth Hamstring Assessment Tool (PHAT), Single Assessment Numeric Evaluation, and Tegner Activity Scale. Of those, PHAT was the only validated outcome measure designed for proximal hamstring repair.
CONCLUSION
There is currently no consensus on the best outcome measurements for the evaluation of patients after proximal hamstring repair. We recommend an increased commitment to the use of return to sport, isokinetic strength testing, Lower Extremity Functional Scale, and PHAT when assessing such injuries. Future studies should aim to define the most reliable methods of outcome measurement in this patient population through consistent use of tools that are clinically relevant and important to patients and can easily be employed in a variety of clinical scenarios.
PubMed: 33997081
DOI: 10.1177/23259671211005101 -
Journal of Hip Preservation Surgery 2023Femoral malversion is an under-recognized contributor to hip pain in younger adults. Under treatment is often a contributor to poor outcomes in hip preservation surgery.... (Review)
Review
Femoral malversion is an under-recognized contributor to hip pain in younger adults. Under treatment is often a contributor to poor outcomes in hip preservation surgery. We reviewed the literature to analyse the outcomes of proximal femoral derotation osteotomy as a treatment for femoral malversion as well as propose our own management algorithm for treating such patients. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines searching four databases (PubMed, CINALH, MEDLINE and EMBASE) for studies investigating the outcomes of derotation osteotomy in treating malversion. Nine studies were found encompassing 229 hips. At a mean follow-up of 39.9 months across the studies, there were only two conversions (1%) to total hip arthroplasty and four revision cases in total. Seven of the nine studies reported improved functional outcomes in their cohorts, with the mean Harris hip score improved from 63.7 to 87.3 where reported. There is a paucity of literature around the outcomes of proximal femoral derotation osteotomy. However, both the evidence available and the authors' experience suggest that consideration of femoral malversion is an essential component of hip preservation surgery, improving functional outcomes in cases of excessive femoral anteversion and femoral retroversion.
PubMed: 38162278
DOI: 10.1093/jhps/hnad024 -
Medicine Apr 2023Retrograde type A dissection (RTAD) is a devastating complication of thoracic endovascular repair (TEVAR) with low incidence but high mortality. The objective of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Retrograde type A dissection (RTAD) is a devastating complication of thoracic endovascular repair (TEVAR) with low incidence but high mortality. The objective of this study is to report the incidence, mortality, potential risk factors, clinical manifestation and diagnostic modalities, and medical and surgical treatments.
METHODS
A systematic review and single-arm and two-arm meta-analyses evaluated all published reports of RTAD post-TEVAR through January 2021. All study types were included, except study protocols and animal studies, without time restrictions. Outcomes of interest were procedural data (implanted stent-grafts type, and proximal stent-graft oversizing), the incidence of RTAD, associated mortality rate, clinical manifestations, diagnostic workouts and therapeutic management.
RESULTS
RTAD occurred in 285 out of 10,600 patients: an estimated RTAD incidence of 2.3% (95% CI: 1.9-2.8); incidence of early RTAD was approximately 1.8 times higher than late. Wilcoxon signed-rank testing showed that the proportion of RTAD patients with acute type B aortic dissection (TBAD) was significantly higher than those with chronic TBAD (P = .008). Pooled meta-analysis showed that the incidence of RTAD with proximal bare stent TEVAR was 2.1-fold higher than with non-bare stents: risk ratio was 1.55 (95% CI: 0.87-2.75; P = .13). Single arm meta-analysis estimated a mortality rate of 42.2% (95% CI: 32.5-51.8), with an I2 heterogeneity of 70.11% (P < .001).
CONCLUSION
RTAD is rare after TEVAR but with high mortality, especially in the first month post-TEVAR with acute TBAD patients at greater risk as well as those treated with proximal bare stent endografts.
Topics: Humans; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Aneurysm Repair; Aortic Aneurysm, Thoracic; Endovascular Procedures; Treatment Outcome; Prosthesis Design; Stents; Aortic Dissection; Risk Factors; Retrospective Studies
PubMed: 37058052
DOI: 10.1097/MD.0000000000032944