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The Journal of Vascular Access Sep 2020To examine the feasibility of snuffbox arteriovenous fistula as a first option for haemodialysis.
PURPOSE
To examine the feasibility of snuffbox arteriovenous fistula as a first option for haemodialysis.
BACKGROUND
Snuffbox arteriovenous fistula is the most distal native anastomosis possible for haemodialysis access. It was described by Rassat et al. This systematic review evaluates all literature investigating the feasibility and efficiency of performing snuffbox arteriovenous fistula.
METHODS
PubMed, Cochrane Library and Google Scholar were systematically searched for all English articles related to snuffbox arteriovenous fistula. Included studies were appraised using relevant appraisal tools.
RESULTS
Eleven papers were included, one prospective trial and the remaining being retrospective. Two trials compared snuffbox arteriovenous fistula to the standard Cimino-Brescia wrist fistula. Factors predicting success included vessel diameter, diabetes, age <70 years, male gender, palpable radial artery, central venous system patency and surgical technique. Patency rates ranged from 61% to 87% at 1-year follow-up and decreased to 36.3%-87% on longer duration follow-up. Ipsilateral radiocephalic fistula was successfully formed in 45%-100% of snuffbox arteriovenous fistula that failed (average of 73.5%).
CONCLUSION
This is a systematic review investigating snuffbox arteriovenous fistula's efficacy. The current literature is scarce and of poor quality; however, it does reflect that, in the well-selected patient, snuffbox arteriovenous fistula is a good and valid option for first-line haemodialysis. It provides a long segment of vessel for needling and also spares the proximal vessels for future use. Ability to effectively convert to wrist fistula in the event of snuffbox arteriovenous fistula failure provides longevity to native haemodialysis access before prosthetic adjuncts are required. This review provides recommendation for well-constructed randomised controlled trials to help delineate snuffbox arteriovenous fistula efficacy and investigate factors that affect success of these fistulas.
Topics: Aged; Arteriovenous Shunt, Surgical; Female; Graft Occlusion, Vascular; Humans; Male; Renal Dialysis; Risk Factors; Thumb; Treatment Outcome; Vascular Patency
PubMed: 31419923
DOI: 10.1177/1129729819867817 -
Aesthetic Plastic Surgery Apr 2020Medical devices such as hip, knee, breast, vascular prostheses, among others, are very useful in different pathologies. We cannot doubt that their use is a great tool,...
INTRODUCTION
Medical devices such as hip, knee, breast, vascular prostheses, among others, are very useful in different pathologies. We cannot doubt that their use is a great tool, besides being an advance in medicine; they provide a change in the quality of life of many patients; however, they are not exempt from adverse reactions and events.
METHODS
We conduct a systematic review about lymphoma in the presences of prostheses other than breast implants.
RESULTS
We selected 21 publications with a total of 24 patients. The largest number of prostheses was related to long bones in a total of 13 prostheses. The most frequent symptoms were: pain (52%), inflammation (24%), visible or palpable mass 20%. The most frequent type of lymphoma was non-Hodgkin B cell lymphoma in 14 cases.
DISCUSSION
The presence of microparticles make biological degradation and wear of the implants, with macrophage and lymphocyte activation and the consequent production of proinflammatory cytokines such as tumor necrosis factor α, interleukin-1β, interleukin-6, and prostaglandin 2 (PGE2).
CONCLUSION
Lymphoma is not a common disease in patients with prostheses, and more data are needed to identify risk factors and make proper diagnoses.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Topics: Breast Implantation; Breast Implants; Humans; Lymphoma; Lymphoma, Large-Cell, Anaplastic; Quality of Life
PubMed: 31844943
DOI: 10.1007/s00266-019-01569-1 -
Journal of Clinical Medicine Jun 2024: The use of miniplates for stabilizing bones post orthognathic surgery has surged in popularity due to their efficacy in ensuring stability and hastening recovery.... (Review)
Review
: The use of miniplates for stabilizing bones post orthognathic surgery has surged in popularity due to their efficacy in ensuring stability and hastening recovery. However, controversy exists regarding what should be done with these miniplates after surgery. Some surgeons advocate for their removal, while others suggest leaving them in place. This study sought to assess the frequency, causes, and potential risk factors linked with miniplate removal in orthognathic procedures. : A thorough meta-analysis was conducted by scrutinizing studies from various databases including PubMed, Google Scholar, Embase, and Scopus, focusing on publications spanning from 1989 to 2023. : Ten studies meeting the inclusion criteria, encompassing 1603 patients, were chosen for inclusion in the meta-analysis. The male-to-female ratio varied from 0.7:1 to 4:1. Overall, 5595 miniplates were inserted, with 294 (5.3%) being subsequently removed. Primary reasons for miniplate removal included infection (161 cases, 2.9%), exposure of miniplates (34 cases, 0.6%), and palpable plates (23 cases, 0.4%). Other indications comprised pain, patient preference, and temperature sensitivity. Less frequent causes for miniplate removal included sinusitis, secondary surgery, and dental pathology. The mean duration of miniplate removal was 5.5 months, with the majority (56.1%) being removed from the mandible rather than the maxilla. In conclusion, this meta-analysis underscores the importance of miniplate removal when hardware causes complications and physical discomfort. The primary reasons for removing miniplates were infection and plate exposure, with the mandible being the most common removal site. : These findings emphasize the need for continued monitoring to assess the fate of miniplates in orthognathic surgery and provide valuable information for future clinical decision-making.
PubMed: 38893045
DOI: 10.3390/jcm13113335 -
Cancers Mar 2024SAVI SCOUT or radar reflector localisation (RRL) has proven accurate in localising non-palpable breast and axillary lesions, with minimal interference with MRI. Targeted... (Review)
Review
Evaluating Radar Reflector Localisation in Targeted Axillary Dissection in Patients Undergoing Neoadjuvant Systemic Therapy for Node-Positive Early Breast Cancer: A Systematic Review and Pooled Analysis.
SAVI SCOUT or radar reflector localisation (RRL) has proven accurate in localising non-palpable breast and axillary lesions, with minimal interference with MRI. Targeted axillary dissection (TAD), combining marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), is becoming a standard post-neoadjuvant systemic therapy (NST) for node-positive early breast cancer. Compared to SLNB alone, TAD reduces the false negative rate (FNR) to below 6%, enabling safer axillary surgery de-escalation. This systematic review evaluates RRL's performance during TAD, assessing localisation and retrieval rates, the concordance between MLNB and SLNB, and the pathological complete response (pCR) in clinically node-positive patients post-NST. Four studies (252 TAD procedures) met the inclusion criteria, with a 99.6% (95% confidence [CI]: 98.9-100) successful localisation rate, 100% retrieval rate, and 81% (95% CI: 76-86) concordance rate between SLNB and MLNB. The average duration from RRL deployment to surgery was 52 days (range:1-202). pCR was observed in 42% (95% CI: 36-48) of cases, with no significant migration or complications reported. Omitting MLNB or SLNB would have under-staged the axilla in 9.7% or 3.4% ( = 0.03) of cases, respectively, underscoring the importance of incorporating MLNB in axillary staging post-NST in initially node-positive patients in line with the updated National Comprehensive Cancer Network (NCCN) guidelines. These findings underscore the excellent efficacy of RRL in TAD for NST-treated patients with positive nodes, aiding in accurate axillary pCR identification and the safe omission of axillary dissection in strong responders.
PubMed: 38611023
DOI: 10.3390/cancers16071345 -
BJS Open Mar 2022Axillary lymph node status remains the most powerful prognostic indicator in invasive breast cancer. Ductal carcinoma in situ (DCIS) is a non-invasive disease and does... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Axillary lymph node status remains the most powerful prognostic indicator in invasive breast cancer. Ductal carcinoma in situ (DCIS) is a non-invasive disease and does not spread to axillary lymph nodes. The presence of an invasive component to DCIS mandates nodal evaluation through sentinel lymph node biopsy (SLNB). Quantification of the necessity of upfront SLNB for DCIS requires investigation. The aim was to establish the likelihood of having a positive SLNB (SLNB+) for DCIS and to establish parameters predictive of SLNB+.
METHODS
A systematic review was performed as per the PRISMA guidelines. Prospective studies only were included. Characteristics predictive of SLNB+ were expressed as dichotomous variables and pooled as odds ratios (o.r.) and associated 95 per cent confidence intervals (c.i.) using the Mantel-Haenszel method.
RESULTS
Overall, 16 studies including 4388 patients were included (mean patient age 54.8 (range 24 to 92) years). Of these, 72.5 per cent of patients underwent SLNB (3156 of 4356 patients) and 4.9 per cent had SLNB+ (153 of 3153 patients). The likelihood of having SLNB+ for DCIS was less than 1 per cent (o.r. <0.01, 95 per cent c.i. 0.00 to 0.01; P < 0.001, I2 = 93 per cent). Palpable DCIS (o.r. 2.01, 95 per cent c.i. 0.64 to 6.24; P = 0.230, I2 = 0 per cent), tumour necrosis (o.r. 3.84, 95 per cent c.i. 0.85 to 17.44; P = 0.080, I2 = 83 per cent), and grade 3 DCIS (o.r. 1.34, 95 per cent c.i. 0.80 to 2.23; P = 0.270, I2 = 0 per cent) all trended towards significance in predicting SLNB+.
CONCLUSION
While aggressive clinicopathological parameters may guide SLNB for patients with DCIS, the absolute and relative risk of SLNB+ for DCIS is less than 5 per cent and 1 per cent, respectively. Well-designed randomized controlled trials are required to establish fully the necessity of SLNB for patients diagnosed with DCIS.
REGISTRATION NUMBER
CRD42021284194 (https://www.crd.york.ac.uk/prospero/).
Topics: Adult; Aged; Aged, 80 and over; Axilla; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Lymphatic Metastasis; Middle Aged; Prospective Studies; Sentinel Lymph Node Biopsy; Young Adult
PubMed: 35380620
DOI: 10.1093/bjsopen/zrac022 -
International Journal of Oral and... Jun 2020The purpose of this review was to analyse the prevalence of titanium plate removal in orthognathic surgery, as well as the causes of plate removal, and to determine the... (Meta-Analysis)
Meta-Analysis
The purpose of this review was to analyse the prevalence of titanium plate removal in orthognathic surgery, as well as the causes of plate removal, and to determine the associated risk factors. A thorough search of the PubMed, Scopus, Embase, and Web of Science databases was conducted. The inclusion criteria were studies of adult patients who underwent orthognathic surgery in which monocortical titanium plates and screws were placed. Of the 325 references identified, 19 were included in the qualitative synthesis and meta-analysis. Overall, 13.4% (95% confidence interval (CI) 9.6-18.3%) of the patients required the removal of at least one titanium plate; 9.7% (95% CI 6.3-14.6%) of the plates placed were removed. The main causes of removal were infection (6.6%), exposed plate (2.6%), thermal sensitivity (2.1%), palpable plate or screw (2.0%), and pain/tenderness (1.9%). Female sex, smoking, and plates placed in the lower jaw were the main risk factors, with odds ratios of 1.5 (95% CI 1.1-2.0), 2.5 (95% CI 1.4-4.2), and 1.8 (95% CI 1.0-3.2), respectively. In no case was a publication bias problem detected. Fixation using titanium plates has a relatively low prevalence of removal. Infection is the main reason for removal. Female sex and smoking, are the main risk factors for removal. Plates placed in the lower jaw is a non-significant risk factor.
Topics: Adult; Bone Plates; Device Removal; Female; Humans; Orthognathic Surgery; Prevalence; Risk Factors; Titanium
PubMed: 31786103
DOI: 10.1016/j.ijom.2019.11.003 -
Journal of Pediatric Surgery Jul 2022Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for...
PURPOSE
Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children.
METHODS
A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020.
RESULTS
A total of 825 articles were identified in the initial search, and 260 were included in the final review.
CONCLUSIONS
Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
Topics: Atrophy; Child; Cryptorchidism; Evidence-Based Practice; Humans; Infant; Male; Orchiopexy; Testicular Neoplasms; Testis; United States
PubMed: 35151498
DOI: 10.1016/j.jpedsurg.2022.01.003 -
JAMA Dermatology Apr 2020The clinical and dermoscopic features of the vast majority of uncommon variants of cutaneous melanoma have been rarely reported, leading to difficulty in making accurate...
IMPORTANCE
The clinical and dermoscopic features of the vast majority of uncommon variants of cutaneous melanoma have been rarely reported, leading to difficulty in making accurate diagnoses.
OBJECTIVE
To define the main clinical and dermoscopic features of the most frequently reported but uncommon histologic variants of cutaneous melanoma.
EVIDENCE REVIEW
A 2-step systematic review of the literature was performed (from inception to November 2018) using PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. The first step identified those uncommon variants of melanoma for which at least 1 case reporting dermoscopy was described in the literature. The keywords searched were melanoma, uncommon, rare, dermoscopy, and dermatoscopy. In the second step, each previously identified uncommon variant was searched for in the same databases by combining the following terms with melanoma, dermoscopy, and dermatoscopy: amelanotic, hypopigmented, animal, melanocytoma, balloon, desmoplastic, follicular, nested, nevoid, dermal, spitz*, spindle, and verrucous. The institution's database was also searched from January 2012 to September 2019 for histopathologically confirmed cases of the same melanoma variants. Each reviewer also assessed the quality of reporting in the included articles based on previously described guidelines.
FINDINGS
In total, 62 articles met the inclusion criteria, reporting 433 melanoma cases. An additional 56 cases of uncommon melanoma variants were retrieved from the institution's database for a total of 489 cases: 283 cases of amelanotic superficial spreading melanoma, 18 cases of animal-type and pigmented epithelioid melanocytoma, 7 cases of balloon cell melanoma, 71 cases of desmoplastic melanoma, 3 cases of follicular melanoma, 10 cases of nested melanoma, 33 cases of nevoid melanoma, 2 cases of primary dermal melanoma, 57 cases of spitzoid melanoma, and 5 cases of verrucous melanoma. These variants of melanoma occurred more frequently in women than men (147 cases vs 132 cases). Clinically, these tumors were mainly palpable (162 of 217 [74.7%]) or amelanotic (283 of 489 [57.9%]) lesions that could resemble other benign or malignant skin conditions; dermoscopy typically revealed a homogeneous pinkish background, white structures, and polymorphic vessels. The mean age of all included was 58 years (range, 1-89 years).
CONCLUSIONS AND RELEVANCE
Uncommon melanoma variants may resemble both inflammatory disorders and other cutaneous neoplasms, representing a diagnostic pitfall even for the most experienced dermatologist. The purpose of this systematic review was to provide an extensive and detailed overview of specific clinical and dermoscopic features of each uncommon melanoma variant, highlighting the main criteria for differentiating these variants from other benign or malignant skin lesions.
Topics: Dermoscopy; Diagnosis, Differential; Humans; Melanoma; Skin Diseases; Skin Neoplasms
PubMed: 32101255
DOI: 10.1001/jamadermatol.2019.4912 -
Journal of Pediatric Urology Aug 2023Contralateral Testis Hypertrophy (CTH) is a clinical marker that could be used to guide the choice of the main surgical strategy. In patients with a Non-palpable Testis... (Review)
Review
BACKGROUND
Contralateral Testis Hypertrophy (CTH) is a clinical marker that could be used to guide the choice of the main surgical strategy. In patients with a Non-palpable Testis (NPT), the degree of CTH as measured by testicular length or volume has been shown to be able to predict whether the undescended testis will survive.
OBJECTIVE
The purpose of this study was to establish the proper cut-off for identifying non-viable testes based on the current literature.
DESIGN
We systematically searched several medical databases as well as Google Scholar search engines for references and citations. All the studies that reported CTH as a result of NPT in prepubertal boys were included. Data from the included articles was gathered by two independent reviewers. The checklist developed by the Joanna Briggs Institute (JBI) was used to evaluate the methodological quality of the studies that were included. Due to the incredibly high degree of heterogeneity among the studies, no meta-analysis was done.
RESULTS
The current systematic review included 17 studies that assessed the cut-off point to detect non-viable testis. The size and length of the testes were taken into consideration based on our findings. We found that different studies reported various ideal cut-off values for predicting non-viable testes, which can be brought on by various measuring techniques, evaluation ages, and patient groupings. The difference in testis volume was greater than the difference in its length, which can be attributable to the fact that some studies used an orchidometer to measure the testis's length directly or indirectly.
CONCLUSION
According to the results of our study, it seems that defining a cut point for diagnosis of CTH based on the size of the testis, cannot demonstrate the absence of a non-palpable testis.
Topics: Male; Humans; Child; Infant; Testis; Cryptorchidism; Hypertrophy; Laparoscopy; Organ Size
PubMed: 36964019
DOI: 10.1016/j.jpurol.2023.03.011 -
BJS Open Sep 2023Accurate tumour localization is crucial for precise surgical targeting and complete tumour removal. Indocyanine green fluorescence, an increasingly used technique in...
BACKGROUND
Accurate tumour localization is crucial for precise surgical targeting and complete tumour removal. Indocyanine green fluorescence, an increasingly used technique in oncological surgery, has shown promise in localizing non-palpable breast tumours. The aim of this systematic review was to describe the efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours.
METHODS
A systematic literature search was performed in PubMed, Embase, and the Cochrane Library, including studies from 2012 to 2023. Studies reporting the proportion of breast tumours identified using indocyanine green fluorescence were included. The quality of the studies and their risk of bias were appraised using the Methodological Index for Non-Randomized Studies ('MINORS') tool. The following outcomes were collected: identification rate, clear resection margins, specimen volume, operative time, re-operation rate, adverse events, and complications.
RESULTS
In total, 2061 articles were screened for eligibility, resulting in 11 studies, with 366 patients included: two RCTs, three non-randomized comparative studies, four single-arm studies, and two case reports. All studies achieved a 100 per cent tumour identification rate with indocyanine green fluorescence, except for one study, with an identification rate of 87 per cent (13/15). Clear resection margins were found in 88-100 per cent of all patients. Reoperation rates ranged from 0.0 to 5.4 per cent and no complications or adverse events related to indocyanine green occurred.
CONCLUSION
Indocyanine green fluorescence has substantial theoretical advantages compared with current routine localization methods. Although a limited number of studies were available, the current literature suggests that indocyanine green fluorescence is a useful, accurate, and safe technique for the intraoperative localization of non-palpable breast tumours, with equivalent efficacy compared with other localization techniques, potentially reducing tumour-positive margins.
Topics: Humans; Female; Fluorescence; Indocyanine Green; Margins of Excision; Operative Time; Breast Neoplasms
PubMed: 37751322
DOI: 10.1093/bjsopen/zrad092