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BJS Open Feb 2018Estimation of the risk of malignancy in intraductal papillary mucinous neoplasia (IPMN) of the pancreas is a clinical challenge. Several routinely used clinical factors... (Review)
Review
BACKGROUND
Estimation of the risk of malignancy in intraductal papillary mucinous neoplasia (IPMN) of the pancreas is a clinical challenge. Several routinely used clinical factors form the basis of the current consensus guidelines. This study aimed to determine the predictive values of the most commonly assessed risk factors.
METHODS
A meta-analysis of individual risk factors of malignancy in IPMN was performed. Contingency tables were derived from these data, and sensitivity, specificity, negative and positive predictive values, and diagnostic odds ratios (DOR) were determined. Hierarchical summary receiver operating characteristic (HSROC) curves for each factor were calculated and the respective area under the curve (AUC) was assessed.
RESULTS
A total of 3443 studies were screened initially. Analysis of recent literature revealed 60 studies with 13 relevant risk factors including clinical, serological and radiological parameters. The largest area under the HSROC curve was found for weight loss (0·84) and jaundice/raised bilirubin level (0·80), followed by increased carcinoembryonic antigen (CEA) (0·79) or carbohydrate antigen (CA) 19-9 (0·78) levels. The most sensitive factors were patient age (71 per cent) and mural nodules (65 per cent), and jaundice/raised bilirubin level (97 per cent) and increased CEA level (95 per cent) were most specific. None of the analysed factors reached a positive or negative level of prediction beyond 90 per cent.
CONCLUSION
None of the established criteria safely distinguishes malignant from non-malignant lesions.
PubMed: 29951625
DOI: 10.1002/bjs5.38 -
World Journal of Surgical Oncology Jun 2017The current study sought to perform a meta-analysis to compare the preoperative staging of endoscopic ultrasonography (EUS) and multidetector computed tomography (MDCT)... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
The current study sought to perform a meta-analysis to compare the preoperative staging of endoscopic ultrasonography (EUS) and multidetector computed tomography (MDCT) in gastric carcinoma.
METHODS
Articles published between January 1, 2000, and April 1, 2016, that compared EUS with MDCT were included, and data were presented as 2 × 2 tables. The sensitivities, specificities and summary receiver operating characteristic (ROC) curves for T and N staging were calculated using a bivariate mixed effects model. Data were weighted by generic variance and then pooled by random-effects modeling.
RESULTS
Eight studies comprising 1736 patients were included in this meta-analysis. For T1 staging, the sensitivity value for EUS (82%) was significantly higher than that for MDCT (41%) (relative risk (RR): 2.06, 95% confidence interval (CI) 1.07-3.94; P = 0.030). For lymph node involvement, the sensitivity value for EUS (91%) was also significantly higher than that for MDCT (77%) (RR 1.14, 95% CI 1.05-1.23; P = 0.001). However, the specificity values of both EUS and MDCT were quite low, at 49 and 63%, respectively. No significant differences in T2-4 staging between EUS and MDCT were noted.
CONCLUSION
This meta-analysis indicates that EUS may be superior to MDCT in preoperative T1 and N staging. Additionally, the low specificity values of EUS and MDCT for N staging merits attention.
Topics: Endosonography; Humans; Multidetector Computed Tomography; Neoplasm Staging; Prognosis; Stomach Neoplasms
PubMed: 28577563
DOI: 10.1186/s12957-017-1176-6 -
Neurological Research and Practice 2019About 5% of all adults will have at least one epileptic seizure in their life. The incidence of all unprovoked seizures ranges from approximately 50 to 70 /100,000. The...
BACKGROUND
About 5% of all adults will have at least one epileptic seizure in their life. The incidence of all unprovoked seizures ranges from approximately 50 to 70 /100,000. The very first epileptic seizure in an adult can be a very decisive event and demands a great deal of responsibility on the part of the treating clinician. Optimal clinical work-up and systematic decision-making are necessary to ensure adequate treatment as well as to avoid unnecessary treatment, such as life-long application of anticonvulsants that may not be indicated.
AIM
To present a pragmatic standard operating procedure (SOP) for approaching the first seizure in adults.
METHOD
Based on current recommendations and personal suggestions, an SOP in the form of a flow chart accompanied with topical explanations and tables was created.
RESULTS
Approaching the first seizure should start with obtaining bystander information on the seizure and its clinical features. Then, differential diagnoses should be considered. The diagnostic work-up hast to contain a neurological and physical examination, emergency blood tests and cerebral imaging. This should allow to differentiate an unprovoked from an acute symptomatic seizure, i.e. triggered by current specific and identifiable structural or metabolic cause that should be eliminated if possible. In the case of an unprovoked seizure, estimation of seizure recurrence is necessary for the decision to start treatment with antiepileptic drugs.
CONCLUSION
The challenge of diagnostic work-up and treatment decisions after a first epileptic seizure in adults may be facilitated by a systematic, SOP-based approach.
PubMed: 33324869
DOI: 10.1186/s42466-019-0006-4 -
Applied Ergonomics Sep 2020Patient lateral transfers between two adjacent surfaces pose high musculoskeletal disorder risks for nurses and patient handlers. The purpose of this research was to...
Patient lateral transfers between two adjacent surfaces pose high musculoskeletal disorder risks for nurses and patient handlers. The purpose of this research was to examine the ergonomic benefits of utilizing the laterally-tilting function of operating room (OR) tables during such transfers - along with different friction-reducing devices (FRD). This method allows the patient to slide down to the adjacent surface as one nurse guides the transfer and another controls the OR table angle with a remote control. Sixteen nursing students and sixteen college students were recruited to act as nurses and patients, respectively. Two OR table angles were examined: flat and tilted. Three FRD conditions were considered: a standard blanket sheet, a plastic bag, and a slide board. Electromyography (EMG) activities were measured bilaterally from the posterior deltoids, upper trapezii, latissimus dorsi, and lumbar erector spinae muscles. The Borg-CR10 scale was used for participants to rate their perceived physical exertions. The efficiency of each method was measured using a stopwatch. Results showed that the tilted table technique completely replaced the physical efforts that would have been exerted by the pushing-nurse, in that muscle activation did not increase in the pulling-nurse. On the contrary, EMG activities of the pulling-nurse for most of the muscles significantly decreased (p < 0.05). The subjective Borg-ratings also favored the tilted table with significantly lower ratings. However, the tilted table required on average 7.22 s more than the flat table to complete the transfer (p < 0.05). The slide board and plastic bag were associated with significantly lower Borg-ratings and EMG activities for most muscles than blanket sheet, but they both were not significantly different from each other. However, they each required approximately 5 s more than the blanket sheet method to complete the patient transfer (p < 0.05). By switching from flat + blanket sheet to tilted + slide board, EMG activities in all muscles decreased in the range of 18.4-72.3%, and Borg-ratings decreased from about 4 (somewhat difficult) to 1 (very light). The findings of this study propose simple, readily available ergonomic interventions for performing patient lateral transfers that can have significant implications for nurses' wellbeing and efficiency.
Topics: Adult; Electromyography; Equipment Design; Ergonomics; Female; Friction; Humans; Lumbosacral Region; Male; Moving and Lifting Patients; Musculoskeletal Diseases; Nurses; Occupational Diseases; Operating Tables; Patient Simulation; Physical Exertion; Shoulder; Work; Young Adult
PubMed: 32501251
DOI: 10.1016/j.apergo.2020.103122 -
La Radiologia Medica Mar 2024To assess the efficacy of radiomics features, obtained by magnetic resonance imaging (MRI) with hepatospecific contrast agent, in pre-surgical setting, to predict RAS...
PURPOSE
To assess the efficacy of radiomics features, obtained by magnetic resonance imaging (MRI) with hepatospecific contrast agent, in pre-surgical setting, to predict RAS mutational status in liver metastases.
METHODS
Patients with MRI in pre-surgical setting were enrolled in a retrospective study. Manual segmentation was made by means 3D Slicer image computing, and 851 radiomics features were extracted as median values using the PyRadiomics Python package. The features were extracted considering the agreement with the Imaging Biomarker Standardization Initiative (IBSI). Balancing was performed through synthesis of samples for the underrepresented classes using the self-adaptive synthetic oversampling (SASYNO) approach. Inter- and intraclass correlation coefficients (ICC) were calculated to assess the between-observer and within-observer reproducibility of all radiomics characteristics. For continuous variables, nonparametric Wilcoxon-Mann-Whitney test was utilized. Benjamini and Hochberg's false discovery rate (FDR) adjustment for multiple testing was used. Receiver operating characteristics (ROC) analysis with the calculation of area under the ROC curve (AUC), sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), negative predictive value (NPV) and accuracy (ACC) were assessed for each parameter. Linear and non-logistic regression model (LRM and NLRM) and different machine learning-based classifiers including decision tree (DT), k-nearest neighbor (KNN) and support vector machine (SVM) were considered. Moreover, features selection were performed before and after a normalized procedure using two different methods (3-sigma and z-score). McNemar test was used to assess differences statistically significant between dichotomic tables. All statistical procedures were done using MATLAB R2021b Statistics and Machine Toolbox (MathWorks, Natick, MA, USA).
RESULTS
Seven normalized radiomics features, extracted from arterial phase, 11 normalized radiomics features, from portal phase, 12 normalized radiomics features from hepatobiliary phase and 12 normalized features from T2-W SPACE sequence were robust predictors of RAS mutational status. The multivariate analysis increased significantly the accuracy in RAS prediction when a LRM was used, combining 12 robust normalized features extracted by VIBE hepatobiliary phase reaching an accuracy of 99%, a sensitivity 97%, a specificity of 100%, a PPV of 100% and a NPV of 98%. No statistically significant increase was obtained, considering the tested classifiers DT, KNN and SVM, both without normalization and with normalization methods.
CONCLUSIONS
Normalized approach in MRI radiomics analysis allows to predict RAS mutational status.
Topics: Humans; Radiomics; Reproducibility of Results; Retrospective Studies; Magnetic Resonance Imaging; Machine Learning
PubMed: 38308061
DOI: 10.1007/s11547-024-01779-x -
Improving surgical efficiency of immediate implant-based breast reconstruction following mastectomy.Breast Cancer Research and Treatment Jul 2019Traditionally, during a mastectomy with implant-based reconstruction, the surgical oncologist completes their operative procedure prior to the reconstructive surgeon...
PURPOSE
Traditionally, during a mastectomy with implant-based reconstruction, the surgical oncologist completes their operative procedure prior to the reconstructive surgeon entering the room. In this scenario, two separate instruments kits and tables are utilized. In our institution, we created a combined instrument kit for use by both surgical teams. We compared set-up and operative times for each process and the subsequent savings associated with this novel approach.
METHODS
Sixty-eight patients undergoing mastectomy with implant-based reconstruction were divided into two groups-those who underwent the procedure with separate oncology and reconstructive kits and those who underwent the procedure with combined instrumentation. Set-up time, procedure time, and clinical outcome endpoints were compared. Costs associated with each process were estimated.
RESULTS
Surgical set-up time was lower using the combined kit versus separate kits [mean for unilateral cases, 25.1 ± 9.6 min vs. 35.7 ± 10.4 min (p < 0.01) and mean for bilateral cases, 33.1 ± 10.3 min vs. 43.5 ± 9.9 min (p = 0.31)]. Procedure time was significantly lower using the combined kit versus separate kits [mean for unilateral cases, 156.2 ± 31.7 min vs. 172.1 ± 33.0 min (p < 0.05) and mean for bilateral cases, 207.3 ± 39.3 min vs. 228. 8 ± 42.7 min (p = 0.03)]. Post-operative outcomes were not significantly different between the two groups at 6 months post-surgery (p = 0.72). Due to a decrease in operating room utilization and costs associated with instrumentation, we estimated $134,396 to $206,621 with unilateral cases and a $289,167 to $465,967 in yearly savings with bilateral cases by using the combined process.
CONCLUSION
Mastectomy with implant-based reconstruction utilizing combined instrumentation, with surgeons working simultaneously, led to decreased operating room utilization and costs without impacting clinical outcomes. Level of evidence II.
Topics: Adult; Aged; Breast Implantation; Breast Neoplasms; Female; Health Care Costs; Humans; Mammaplasty; Mastectomy; Middle Aged; Operative Time; Retrospective Studies; Treatment Outcome
PubMed: 30977025
DOI: 10.1007/s10549-019-05175-2 -
Journal of Oral and Maxillofacial... Dec 2020In an effort to protect health care workers at the beginning and end of oral and maxillofacial surgeries, we describe a negative-pressure intubation hood (NPIH) designed...
PURPOSE
In an effort to protect health care workers at the beginning and end of oral and maxillofacial surgeries, we describe a negative-pressure intubation hood (NPIH) designed to reduce the risk aerosol exposure from fiberoptic intubation (FOI) and extubation. This design is especially important during the Coronavirus disease 2019 era, as it provides greater protection from Severe Acute Respiratory Syndrome-Coronavirus-2 during FOI and extubation, which are some of the most high-risk, aerosol generating procedures of oral and maxillofacial surgery cases.
MATERIALS AND METHODS
This article describes the step-by-step process of assembling a NPIH for FOI using various supplies found commonly in hospitals and surrounding community retail stores, which include transparent medical dressings, equipment covers, intravenous pole clips, polyvinylchloride pipes and adaptors, copper pipe, and a Buffalo smoke evacuator. We then discuss how to create access ports for the anesthesiologist to insert their arms and FOI instrumentation and provide a demonstration of us using the hood with a manikin on an operating room table.
RESULTS
This study successfully demonstrates a novel technique for performing FOI in a NIPH assembled from basic supplies found commonly among hospital and community retail stores.
CONCLUSIONS
This NIPH for FOI is easily made and adaptable to operating room tables, and provides protection against aerosols generated from FOI and subsequent extubation during oral and maxillofacial surgeries.
Topics: COVID-19; Humans; Intubation, Intratracheal; Pandemics; SARS-CoV-2
PubMed: 32822615
DOI: 10.1016/j.joms.2020.07.027 -
Journal of Pediatric Orthopedics. Part B Sep 2020Children's femoral shaft fractures are commonly treated with flexible intramedullary nailing after closed or open reduction, but there is little information concerning...
Children's femoral shaft fractures are commonly treated with flexible intramedullary nailing after closed or open reduction, but there is little information concerning indications for open reduction. The purpose of this study was to determine radiographic and clinical features likely to lead to open reduction before flexible intramedullary nailing. Record review identified 158 femoral shaft fractures treated with flexible intramedullary nailing. In addition to patient demographics and mechanism of injury, data obtained included surgeon name, estimated blood loss, type of reduction, type and diameter of nail, type of operating table, the use of percutaneous reduction techniques or supplemental casting, time to and duration of surgery, total time in operating room, and time to union. Fracture ratios were calculated based on established radiographic protocol. Of 158 fractures, 141 were treated with closed reduction and 17 with open reduction. The anteroposterior fracture index (1.3 ± 0.4, P = 0.0007), surgeon (P = 0.002), and flattop operating table (0.05) were associated with open reduction. Smaller lateral diameter of bone at the fracture site, transverse fracture, and surgeon were all found to be independent risk factors for open reduction; patient characteristics, including age, sex, and BMI, did not seem to influence the choice of open reduction. Fractures with a lower fracture index or pattern resembling a transverse fracture rather than oblique or spiral had an increased risk of converting to an open reduction. Surgeon preference and use of flattop tables also had a significant influence on how the fracture was treated.
Topics: Bone Nails; Child; Closed Fracture Reduction; Decision Support Techniques; Female; Femoral Fractures; Humans; Injury Severity Score; Male; Open Fracture Reduction
PubMed: 31651747
DOI: 10.1097/BPB.0000000000000685 -
RoFo : Fortschritte Auf Dem Gebiete Der... Feb 2021To examine the relationship between superficial lesions (such as bruises, hematomas, deep abrasions, and soft tissue emphysema) and internal post-traumatic injuries,...
PURPOSE
To examine the relationship between superficial lesions (such as bruises, hematomas, deep abrasions, and soft tissue emphysema) and internal post-traumatic injuries, assessed using whole-body computed tomography (WBCT), and to determine if these are valid markers for internal injuries.
METHODS AND MATERIALS
250 patients who underwent WBCT emergency scans for suspected polytrauma were retrospectively analyzed after institutional review board approval of the study. The scans were carried out on patients who met the criteria for standard operating procedures for WBCT emergency scans. WBCT covering the entire head, neck, chest, and abdomen (including pelvis and proximal lower extremities) and at least one phase with intravenous contrast agent were included in the study. Initial analyses of immediate WBCT scans was carried out by a consultant radiologist and a radiological resident. The first reading focused on internal damage that needed immediate therapy. The second reading focused on a detailed analysis of the skin and subcutaneous tissue and their relation to internal injuries without the time pressure of an emergency setting, carried out by another experienced radiologist. All skin lesions and the degree of penetration and a comparison between the two readings were reported in tables.
RESULTS
Superficial lesion of the chest was detected in 19 patients, 17 of them had an internal injury of the thorax while only two patients, with hematoma of the chest wall, had no internal injuries. Skin and subcutaneous lesions of the chest had the strongest association with an internal injury. Skin lesions of the abdominal wall were observed in 30 patients. In only 11 cases, these lesions were correlated with internal injuries, such as fractures or active bleeding. 52 skin and subgaleal lesions of the scalp were observed. In 20 of these patients, an intracranial or internal injury was detected. In 3 patients, skin abrasions of the neck were present and in only one of them, this finding was associated with an internal injury.
CONCLUSION
Trauma patients whose history and clinical presentation meet the standard operating procedures for WBCT emergency scans and who present with a cutaneous lesion, especially at the neurocranium or chest wall, should be observed for internal injuries by WBCT.
KEY POINTS
· Presence or lack of a superficial injury of the abdominal wall is not a reliable predictive indication of any internal abdominal injury.. · Superficial lesions of the chest and the neurocranium require a CT scan.. · Superficial injuries of the chest wall had the strongest association with internal injuries..
CITATION FORMAT
· Klempka A, Fischer C, Kauczor H et al. Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Trauma. Fortschr Röntgenstr 2021; 193: 177 - 185.
Topics: Abdominal Injuries; Administration, Intravenous; Adult; Aged; Awareness; Contrast Media; Craniocerebral Trauma; Emergency Service, Hospital; Female; Humans; Injury Severity Score; Male; Middle Aged; Multiple Trauma; Radiologists; Retrospective Studies; Skin; Subcutaneous Tissue; Thoracic Injuries; Tomography, X-Ray Computed; Whole Body Imaging
PubMed: 33242897
DOI: 10.1055/a-1207-0797 -
International Wound Journal Oct 2020An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her... (Review)
Review
An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning-related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.
Topics: Female; Humans; Male; Operating Rooms; Pressure Ulcer; Risk Assessment; Risk Factors
PubMed: 32496025
DOI: 10.1111/iwj.13408