-
Children (Basel, Switzerland) Aug 2021Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a... (Review)
Review
BACKGROUND
Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a laparoscopic approach in the treatment of palpable cryptorchidism. The present systematic review and meta-analysis investigated the utility of laparoscopic orchiopexy for palpable cryptorchidism.
METHODS
Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant articles using the following terms: (palpable cryptorchidism or palpable undescended testes) AND (laparoscopic orchiopexy or laparoscopic orchiopexy). The inclusion criteria were all children with unilateral or bilateral palpable undescended testes who underwent laparoscopic orchiopexy (LO) compared to children who underwent conventional open orchiopexy (CO). The main outcomes were the proportion of children requiring redo-orchiopexy and the incidence of postoperative complications. Secondary outcomes were duration and the cost of surgery.
RESULTS
The final meta-analysis included five studies involving 705 children; LO, = 369 (52.3%) and CO, = 336 (47.7%). The majority of the included patients had unilateral palpable cryptorchidism. No significant differences were found in regard to average age at the time of surgery and follow-up periods between the investigated groups. No statistically significant differences were found in regard to redo-orchiopexy rates (RR = 0.22, 95% CI 0.03-1.88, = 0.17), early complications (RR = 0.66, 95% CI 0.21-2.08, = 0.48) and incidence of testicular atrophy (RR = 0.36, 95% CI 0.03-3.88, = 0.40). No significant differences in the operative duration were observed among the groups. Laparoscopy was associated with higher costs in most of the studies.
CONCLUSION
LO is safe and effective in children with palpable cryptorchidism. The rates of redo-orchiopexy as well as an incidence of early complications and testicular atrophy rates are comparable to CO.
PubMed: 34438568
DOI: 10.3390/children8080677 -
Endocrine Nov 2021Nearly half the cases of thyroid cancer, a malignancy rapidly rising in incidence within the United States, are attributable to small and asymptomatic papillary thyroid... (Meta-Analysis)
Meta-Analysis
PURPOSE
Nearly half the cases of thyroid cancer, a malignancy rapidly rising in incidence within the United States, are attributable to small and asymptomatic papillary thyroid cancers that will not increase mortality. A primary driver of thyroid cancer overdiagnosis is ultrasound use. It is therefore valuable to understand how inappropriate use of thyroid ultrasound is defined, analyze the current evidence for its frequency, and identify interventions to lessen misuse.
METHODS
Ovid MEDLINE(R), Ovid EMBASE, and Scopus databases were searched from inception to June 2020 for studies assessing inappropriate use of thyroid ultrasound. Reviewers, working independently and in duplicate, evaluated studies for inclusion, extracted data, and graded risk of bias. We used a random-effects model with a generalized linear mixed approach to calculate the mean overall proportion estimates of inappropriate use.
RESULTS
Seven studies (total n = 1573) met the inclusion criteria with moderate to high risk of bias. Inappropriate thyroid ultrasound use was described variably, using published practice guidelines, third-party expert reviewers, or author interpretations of the literature. The overall frequency of inappropriate thyroid ultrasound use was 46% (95% CI 15-82%; n = 388) and 34% (95% CI 16-57%; n = 190) among studies using guideline based definitions. The pooled frequency of iUS due to thyroid dysfunction (either hypothyroidism or thyrotoxicosis) was 17% (95% CI 7-37%; n = 191) and the frequency of iUS due to nonspecific symptoms without a palpable mass was 11% (95% CI 5-22%; n = 124). No study examined interventions to address inappropriate use.
CONCLUSIONS
Low quality evidence suggests that inappropriate use of thyroid ultrasound is common. Interventional studies aiming to decrease the inappropriate use of thyroid ultrasound are urgently needed.
Topics: Humans; Thyroid Cancer, Papillary; Thyroid Neoplasms; Ultrasonography
PubMed: 34379311
DOI: 10.1007/s12020-021-02820-z -
Medicina (Kaunas, Lithuania) May 2021cardiovascular complications (CVC) are the leading cause of death in patients with chronic kidney disease (CKD). Standard cardiovascular disease risk prediction models... (Review)
Review
cardiovascular complications (CVC) are the leading cause of death in patients with chronic kidney disease (CKD). Standard cardiovascular disease risk prediction models used in the general population are not validated in patients with CKD. We aim to systematically review the up-to-date literature on reported outcomes of computational methods such as artificial intelligence (AI) or regression-based models to predict CVC in CKD patients. the electronic databases of MEDLINE/PubMed, EMBASE, and ScienceDirect were systematically searched. The risk of bias and reporting quality for each study were assessed against transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) and the prediction model risk of bias assessment tool (PROBAST). sixteen papers were included in the present systematic review: 15 non-randomized studies and 1 ongoing clinical trial. Twelve studies were found to perform AI or regression-based predictions of CVC in CKD, either through single or composite endpoints. Four studies have come up with computational solutions for other CV-related predictions in the CKD population. the identified studies represent palpable trends in areas of clinical promise with an encouraging present-day performance. However, there is a clear need for more extensive application of rigorous methodologies. Following the future prospective, randomized clinical trials, and thorough external validations, computational solutions will fill the gap in cardiovascular predictive tools for chronic kidney disease.
Topics: Artificial Intelligence; Bias; Computer Simulation; Humans; Prognosis; Renal Insufficiency, Chronic
PubMed: 34072159
DOI: 10.3390/medicina57060538 -
Breast (Edinburgh, Scotland) Aug 2021Pre-operative localization of non-palpable breast lesions with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as reoperation rate, cosmetic... (Meta-Analysis)
Meta-Analysis Review
Pre-operative localization of non-palpable breast lesions with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as reoperation rate, cosmetic outcome and contribute to organizational aspects improvement in breast-conserving surgery (BCS). However only limited literature is available and clinical studies involving these forefront devices are often small and non-randomized. Furthermore, there is a lack of consensus on free margins and cosmetic outcomes definitions. The objective of the present meta-analysis was to determine the crude clinical outcomes reported for the NWNI techniques on BCS. A literature search was performed of PubMed, Embase and Scopus databases up to February 2021 in order to select all prospective or retrospective clinical trials on pre-operative breast lesion localization done with NWNI devices. All studies were assessed following the PRISMA recommendations. Continuous outcomes were described in averages corrected for sample size, while binomial outcomes were described using the weighted average proportion. Twenty-seven studies with a total of 2103 procedures were identified. The technique is consolidated, showing for both reflectors' positioning and localization nearly the 100% rate of success. The re-excision and clear margins rates were 14% (95% CI, 11-17%) and 87% (80-92%), respectively. Overall, positive margins rates were 12% (8-17%). In studies that compared NWNI and wire localization techniques, positive margin rate is lower for the first techniques (12%, 6-22% vs 17%, 12-23%) and re-excision rate is slightly higher using the latter (13%, 9-19% vs 16%, 13-18%). Pre-operative NWNI techniques are effective in the localization of non-palpable breast lesions and are promising in obtaining clear (or negative) margins minimizing the need for re-excision and improving the cosmetic outcomes. Randomized trials are needed to confirm these findings.
Topics: Breast Neoplasms; Female; Humans; Margins of Excision; Mastectomy, Segmental; Prospective Studies; Reoperation; Retrospective Studies
PubMed: 33991806
DOI: 10.1016/j.breast.2021.04.007 -
Langenbeck's Archives of Surgery Mar 2022Composite phaeochromocytoma is a tumour containing a separate tumour of neuronal origin in addition to a chromaffin cell tumour. This study reports on two cases from a... (Review)
Review
INTRODUCTION
Composite phaeochromocytoma is a tumour containing a separate tumour of neuronal origin in addition to a chromaffin cell tumour. This study reports on two cases from a single centre's records and presents a systematic literature review of composite phaeochromocytomas.
METHODS
In addition to describing 2 case reports, a systematic search of the Medline database from inception up to April 2020 was done for human case reports on composite phaeochromocytomas. Relevant titles and/or abstracts were screened, and full texts were reviewed to identify appropriate studies. Data was extracted and a descriptive analysis of presentation, clinical features, management strategies and outcomes was performed. The quality of included studies was assessed using a critical appraisal checklist.
RESULTS
There were 62 studies included, with a total of 94 patients. Of 91 patients where data was available, the median (range) age of patients was 48 (4-86) years. Of 90 patients where information was provided, 57% were female. In at least 28% of patients, a genetic cause was identified. Common presenting features include abdominal pain, palpable mass, cardiovascular and gastrointestinal symptoms. The most common tumour component with phaeochromocytoma is ganglioneuroma; other components include ganglioneuroblastoma, neuroblastoma and malignant peripheral nerve sheath tumours. In patients with follow-up data (n=48), 85% of patients were alive and well at a median (range) follow-up time of 18 (0.5-168) months.
CONCLUSION
Composite phaeochromocytoma is a rare tumour, with a significant genetic predisposition. This review summarises available epidemiological data, which will be useful for clinicians managing this rare condition.
Topics: Adrenal Gland Neoplasms; Aged; Aged, 80 and over; Brain Neoplasms; Female; Humans; Middle Aged; Pheochromocytoma
PubMed: 33651160
DOI: 10.1007/s00423-021-02129-5 -
European Review For Medical and... Feb 2021The aim of the study was to summarize and update evidence on whether intra-operative ultrasonography (IOUS) guided breast conserving surgery (BCS) can be more effective... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
The aim of the study was to summarize and update evidence on whether intra-operative ultrasonography (IOUS) guided breast conserving surgery (BCS) can be more effective than wire-guided or palpation-guided excision for both nonpalpable, as well as palpable breast cancers in achieving tumor free negative margins after lumpectomy for breast cancer.
MATERIALS AND METHODS
Comprehensive searches were done systematically through PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases. Statistical analysis was done using STATA version 13.0. The primary outcome was proportion of patients that achieved tumor free resection margins after lumpectomy. Effect sizes were reported as pooled relative risks (RR). All estimates were reported with 95% confidence intervals (CI).
RESULTS
A total of 20 RCTs with 2519 participants were included in the meta-analysis. Use of intra-operative ultrasonography was associated with 1.18 times higher chances [RR 1.18; 95% CI, 1.10-1.27] of attaining a tumor free margin for all breast cancers, 1.16 times higher chances [RR 1.16; 95% CI, 1.10-1.23] of attaining a tumor free margin for all palpable breast cancers and 1.20 times higher chances [RR 1.20; 95% CI, 1.05-1.38] of attaining a tumor free margin for all non-palpable breast, compared to wire guided or palpation guided localization. There was no evidence of publication bias.
CONCLUSIONS
The findings support that intra-operative ultrasonography increases the chances of obtaining negative margins for tissue resected in breast conserving surgeries. The findings support the observations of previous reviews published in this aspect nearly half a decade back.
Topics: Breast Neoplasms; Female; Humans; Ultrasonography, Mammary
PubMed: 33629309
DOI: 10.26355/eurrev_202102_24847 -
The Cochrane Database of Systematic... Jan 2021Primary liver tumours and liver metastases from colorectal carcinoma are two of the most common malignant tumours to affect the liver. The liver is second only to the...
BACKGROUND
Primary liver tumours and liver metastases from colorectal carcinoma are two of the most common malignant tumours to affect the liver. The liver is second only to the lymph nodes as the most common site for metastatic disease. More than half of the people with metastatic liver disease will die from metastatic complications. Electrocoagulation by diathermy is a method used to destroy tumour tissue, using a high-frequency electric current generating high temperatures, applied locally with an electrode (needle, blade, or ball). The objective of this method is to destroy the tumour completely, if possible, in a single session. With the time, electrocoagulation by diathermy has been replaced by other techniques, but the evidence is unclear.
OBJECTIVES
To assess the beneficial and harmful effects of electrocoagulation by diathermy, administered alone or with another intervention, versus no intervention, other ablation methods, or systemic treatments in people with liver metastases.
SEARCH METHODS
We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, LILACS, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, CINAHL, ClinicalTrials.gov, ICTRP, and FDA to October 2020.
SELECTION CRITERIA
We considered all randomised trials that assessed beneficial and harmful effects of electrocoagulation by diathermy, administered alone or with another intervention, versus comparators, in people with liver metastases, regardless of the location of the primary tumour.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We assessed risk of bias of the included trial using predefined risk of bias domains, and presented the review results incorporating the certainty of the evidence using GRADE.
MAIN RESULTS
We included one randomised clinical trial with 306 participants (175 males; 131 females) who had undergone resection of the sigmoid colon, and who had five or more visible and palpable hepatic metastases. The diagnosis was confirmed by histological assessment (biopsy) and by carcinoembryonic antigen (CEA) level. The trial was conducted in Iraq. The age of participants ranged between 38 and 79 years. The participants were randomised to four different study groups. The liver metastases were biopsied and treated (only once) in three of the groups: 75 received electrocoagulation by diathermy alone, 76 received electrocoagulation plus allopurinol, 78 received electrocoagulation plus dimethyl sulphoxide. In the fourth intervention group, 77 participants functioning as controls received a vehicle solution of allopurinol 5 mL 4 x a day by mouth; the metastases were left untouched. The status of the liver and lungs was followed by ultrasound investigations, without the use of a contrast agent. Participants were followed for five years. The analyses are based on per-protocol data only analysing 223 participants. We judged the trial to be at high risk of bias. After excluding 'nonevaluable patients', the groups seemed comparable for baseline characteristics. Mortality due to disease spread at five-year follow-up was 98% in the electrocoagulation group (57/58 evaluable people); 87% in the electrocoagulation plus allopurinol group (46/53 evaluable people); 86% in the electrocoagulation plus dimethyl sulphoxide group (49/57 evaluable people); and 100% in the control group (55/55 evaluable people). We observed no difference in mortality between the electrocoagulation alone group versus the control group (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.94 to 1.03; 113 participants; very low-certainty evidence). We observed lower mortality in the electrocoagulation combined with allopurinol or dimethyl sulphoxide group versus the control group (RR 0.87, 95% CI 0.80 to 0.95; 165 participants; low-certainty evidence). We are very uncertain regarding post-operative deaths between the electrocoagulation alone group versus the control group (RR 1.03, 95% CI 0.07 to 16.12; 152 participants; very low-certainty evidence) and between the electrocoagulation combined with allopurinol or dimethyl sulphoxide groups versus the control group (RR 1.00, 95% CI 0.09 to 10.86; 231 participants; very low-certainty evidence). The trial authors did not report data on number of participants with other adverse events and complications, recurrence of liver metastases, time to progression of liver metastases, tumour response measures, and health-related quality of life. Data on failure to clear liver metastases were not provided for the control group. There was no information on funding or conflict of interest. We identified no ongoing trials.
AUTHORS' CONCLUSIONS
The evidence on the beneficial and harmful effects of electrocoagulation alone or in combination with allopurinol or dimethyl sulphoxide in people with liver metastases is insufficient, as it is based on one randomised clinical trial at low to very low certainty. It is very uncertain if there is a difference in all-cause mortality and post-operative mortality between electrocoagulation alone versus control. It is also uncertain if electrocoagulation in combination with allopurinol or dimethyl sulphoxide may result in a slight reduction of all-cause mortality in comparison with a vehicle solution of allopurinol (control). It is very uncertain if there is a difference in post-operative mortality between the electrocoagulation combined with allopurinol or dimethyl sulphoxide group versus control. Data on other adverse events and complications, failure to clear liver metastases or recurrence of liver metastases, time to progression of liver metastases, tumour response measures, and health-related quality of life were most lacking or insufficiently reported for analysis. Electrocoagulation by diathermy is no longer used in the described way, and this may explain the lack of further trials.
Topics: Adult; Aged; Allopurinol; Cause of Death; Colonic Neoplasms; Dimethyl Sulfoxide; Electrocoagulation; Female; Humans; Liver Neoplasms; Male; Middle Aged; Randomized Controlled Trials as Topic; Solvents
PubMed: 33507555
DOI: 10.1002/14651858.CD009497.pub3 -
Heart & Lung : the Journal of Critical... 2020Peripheral venous catheterization is a common technique in hospitals which is not always successful, resulting in multiple punctures and degradation of the vessels. This... (Meta-Analysis)
Meta-Analysis
Peripheral venous catheterization is a common technique in hospitals which is not always successful, resulting in multiple punctures and degradation of the vessels. This scenario, which we have termed 'difficult peripheral venous access', is associated to delays in care, obtention of samples or diagnosis, as well as a higher use of central catheters. This study intends to identify risk factors associated to the incidence of 'difficult peripheral venous access' in adults at hospital. We designed a systematic review of published studies (protocol PROSPERO 2018 CRD42018089160). We conducted structured electronic searches using key words and specific vocabulary, as well as directed searches in several databases. After validity analysis, we selected 7 studies with observational methodology. We found great variability in the definition of 'difficult peripheral venous access' and in the variables proposed as risk factors. Statistically significant factors through studies include demographic and anthropometric variables (gender, Body Mass Index), as well as medical and health conditions (diabetes, renal insufficiency, parenteral drug abuse, cancer chemotherapy), together with variables related to the vein or vascular access (vein visibility and palpability, vessel diameter, previous history of difficulty). Some studies have also considered variables related to the professional performing the technique. Meta-analyses were carried out for gender and obesity as potential risk factors. Only obesity appeared as a statistically significant risk factor with OR of 1.48; 95% CI (1.03 to 1.93; p = 0.016). Methodological heterogeneity prevented the development of further meta-analyses. It is essential to design future studies with diverse hospital populations, in which a wide selection of potential risk factors can be studied in a unique analysis. Our work identifies the most relevant variables that should be included in those studies.
Topics: Adult; Body Mass Index; Catheterization, Central Venous; Catheterization, Peripheral; Humans; Punctures; Risk Factors; Veins
PubMed: 32057426
DOI: 10.1016/j.hrtlng.2020.01.009 -
Clinical and Experimental Pediatrics May 2020IgA vasculitis, formerly known as Henoch-Schönlein purpura, is a systemic IgA-mediated vasculitis of the small vessels commonly seen in children. The natural history of...
IgA vasculitis, formerly known as Henoch-Schönlein purpura, is a systemic IgA-mediated vasculitis of the small vessels commonly seen in children. The natural history of IgA vasculitis is generally self-limiting; however, one-third of patients experience symptom recurrence and a refractory course. This systematic review examined the use of dapsone in refractory IgA vasculitis cases. A literature search of PubMed databases retrieved 13 articles published until June 14, 2018. The most common clinical feature was a palpable rash (100% of patients), followed by joint pain (69.2%). Treatment response within 1-2 days was observed in 6 of 26 patients (23.1%) versus within 3-7 days in 17 patients (65.4%). Relapse after treatment discontinuation was reported in 17 patients (65.4%) but not in 3 patients (11.5 %). Four of the 26 patients (15.4%) reported adverse effects of dapsone including arthralgia (7.7%), rash (7.7%), and dapsone hypersensitivity syndrome (3.8%). Our findings suggest that dapsone may affect refractory IgA vasculitis. Multicenter randomized placebo-controlled trials are necessary to determine the standard dosage of dapsone at initial or tapering of treatment in IgA vasculitis patients and evaluate whether dapsone has a significant benefit versus steroids or other medications.
PubMed: 32024340
DOI: 10.3345/kjp.2019.00514 -
Archivos Espanoles de Urologia Dec 2019Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and...
OBJECTIVES
Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes in video-endoscopic inguinal lymphadenectomy (VEIL).
METHODS
A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles.
RESULTS
Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach.
CONCLUSION
Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower- rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results.
Topics: Endoscopy; Humans; Inguinal Canal; Lymph Node Excision; Male; Middle Aged; Penile Neoplasms; Video-Assisted Surgery
PubMed: 31823847
DOI: No ID Found