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Stomatologija 2018To review all of the possible uses for maxillary sinus lateral wall bony window in an open maxillary sinus lift procedure and to evaluate the influence of each method to... (Review)
Review
AIM
To review all of the possible uses for maxillary sinus lateral wall bony window in an open maxillary sinus lift procedure and to evaluate the influence of each method to the rate of sinus membrane perforations.
METHODS
A systematic literature review was performed of randomized control studies in English identified in MEDLINE (PubMed) and Cochrane online databases, published between 2007.09.01 and 2017.09.01. Surgeries had to be performed in vivo, for patients over 18 years old. A study had to have at least 10 sinus lifting procedures, had to detail how the bony window was used and had to report the number of Schneiderian membrane perforations.
RESULTS
922 publications were found, out of which 68 were selected for qualitative assessment. 29 of them were selected for quantitative assessment. 4 distinct uses for bony window were found: bony window is elevated into the sinus cavity under the membrane; removed and discarded; repositioned to its original position after the surgery; used as a graft material for sinus lift.
CONCLUSIONS
there is a statistically significant difference of sinus membrane perforations between different uses of the lateral bony window of an open sinus lift procedure. However, due to the lack of publications that investigate the effects of different bony window usage methods, clinical recommendations cannot be drawn from current data.
Topics: Humans; Maxilla; Maxillary Sinus; Osteotomy; Sinus Floor Augmentation
PubMed: 29806654
DOI: No ID Found -
BMJ Clinical Evidence Jul 2007Potential causes of appendicitis include faecoliths, lymphoid hyperplasia, and caecal carcinoma, all of which can lead to obstruction of the appendix lumen. The lifetime... (Review)
Review
INTRODUCTION
Potential causes of appendicitis include faecoliths, lymphoid hyperplasia, and caecal carcinoma, all of which can lead to obstruction of the appendix lumen. The lifetime risk is approximately 7-9% in the USA, making appendicectomy the most common abdominal surgical emergency. Mortality from acute appendicitis is less than 0.3%, but rises to 1.7% after perforation.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute appendicitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 10 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, laparoscopic surgery, ligation, open surgery, stump inversion, surgery.
Topics: Acute Disease; Appendectomy; Appendicitis; Appendix; Humans; Intestinal Perforation; Laparoscopy; Prospective Studies
PubMed: 19454096
DOI: No ID Found -
Open Heart Oct 2022Coronary perforation is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We studied incidence, outcomes and temporal trends... (Meta-Analysis)
Meta-Analysis
UNLABELLED
Coronary perforation is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We studied incidence, outcomes and temporal trends following PCI-related coronary artery perforation (CAP).
METHODS
Prospective systematic review and meta-analysis including meta-regression using MEDLINE and EMBASE to November 2020. We included 'all-comer' PCI cohorts including large PCI registries and randomised controlled trials and excluding registries or trials limited to PCI in high-risk populations such as chronic total occlusion PCI or cohorts treated only with atheroablative devices. Regression analysis and corresponding correlation coefficients were performed comparing perforation incidence, mortality rate, tamponade rate and the rate of Ellis III perforations against the midpoint (year) of data collection to determine if a significant temporal relationship was present.
RESULTS
3997 studies were screened for inclusion. 67 studies met eligibility criteria with a total of 5 568 191 PCIs included over a 38-year period (1982-2020). The overall pooled incidence of perforation was 0.39% (95% CI 0.34% to 0.45%) and remained similar throughout the study period. Around 1 in 5 coronary perforations led to tamponade (21.1%). Ellis III perforations are increasing in frequency and account for 43% of all perforations. Perforation mortality has trended lower over the years (7.5%; 95% CI 6.7% to 8.4%). Perforation risk factors derived using meta-regression were female sex, hypertension, chronic kidney disease and previous coronary bypass grafting. Coronary perforation was most frequently caused by distal wire exit (37%) followed by balloon dilation catheters (28%). Covered stents were used to treat 25% of perforations, with emergency cardiac surgery needed in 17%.
CONCLUSION
Coronary perforation complicates approximately 1 in 250 PCIs. Ellis III perforations are increasing in incidence although it is unclear whether this is due to reporting bias. Despite this, the overall perforation mortality rate (7.5%) has trended lower in recent years. Limitations of our findings include bias that may be introduced through analysis of multidesign studies and registries without pre-specified standardised perforation reporting CMore research into coronary perforation management including the optimal use of covered stents seems warranted.
PROSPERO REGISTRATION NUMBER
CRD42020207881.
Topics: Female; Humans; Male; Percutaneous Coronary Intervention; Incidence; Prospective Studies; Heart Injuries; Coronary Vessels
PubMed: 36270713
DOI: 10.1136/openhrt-2022-002076 -
International Journal of Surgery... 2012Gallbladder perforation is a serious complication of acute cholecystitis. Its management has evolved considerably since its classification by Niemeier in 1934. This... (Review)
Review
BACKGROUND
Gallbladder perforation is a serious complication of acute cholecystitis. Its management has evolved considerably since its classification by Niemeier in 1934. This review summarises the evidence surrounding the natural progression of this condition and potential problems with Niemeier's classification, and proposes a management algorithm for the more complex type II perforation.
METHODS
Data from a retrospective case series and a systematic review were combined. The case series included all patients with gallbladder perforations from 2004 to 2008 at a British teaching hospital. The systematic review searched for gallbladder perforation using the MEDLINE, Embase, Web of Science and Cochrane Library (2011 Issue 4) databases, as well as recent conference abstracts. The outcome data were analysed using SPSS version 15. No adjustments were made for multiple testing.
RESULTS
198 patients (including 19 patients from the present series) with a mean age of 62.1+/-9.7 years and male gender proportion of 55.4% (range 33.3-76.7%) were included. The most common gallbladder perforations were type II (median 46.2%, range 7.4-83.3%), followed by type I (median 40.6%, range 16.7-70.0%) and type III (median 10.1%, range 0-48.1%). Perforation was associated with cholelithiasis in 86.6% (range 78.9-90.6%) of patients, and the overall median mortality rate was 10.8% (range 0-12.5%). Male gender was weakly associated with mortality (p = 0.089) but age (p = 0.877) and cholelithiasis (p = 0.425) were not. Mortality did not vary significantly with perforation type.
CONCLUSIONS
Gallbladder perforation should be reported according to the original Neimeier's classification to avoid heterogeneity in data (e.g. varying rates of perforation types). The algorithm proposed in this study aims to guide the management of complex type II gallbladder perforations to minimise subsequent morbidity and mortality.
Topics: Adult; Aged; Aged, 80 and over; Algorithms; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholecystitis, Acute; Decision Support Techniques; Female; Gallbladder Diseases; Humans; Male; Middle Aged; Retrospective Studies; Rupture, Spontaneous
PubMed: 22210542
DOI: 10.1016/j.ijsu.2011.12.004 -
BMJ Clinical Evidence Mar 2011Diverticula (mucosal outpouching through the wall of the colon) are rare before the age of 40 years, after which prevalence increases steadily and reaches over 25% by 60... (Review)
Review
INTRODUCTION
Diverticula (mucosal outpouching through the wall of the colon) are rare before the age of 40 years, after which prevalence increases steadily and reaches over 25% by 60 years. However, only 10% to 25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: treatments for uncomplicated diverticular disease; treatments to prevent complications; and treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antispasmodics, elective surgery, increasing fibre intake with bran or ispaghula husk, lactulose, medical treatment, mesalazine, methylcellulose, rifaximin, and surgery.
Topics: Abdominal Pain; Acute Disease; Dietary Fiber; Diverticulitis; Diverticulosis, Colonic; Diverticulum; Humans
PubMed: 21401970
DOI: No ID Found -
HPB : the Official Journal of the... Nov 2021The optimal management of localized gallbladder perforation (Neimeier type II) has yet to be defined. The aim of this systematic review was to identify factors... (Review)
Review
BACKGROUND
The optimal management of localized gallbladder perforation (Neimeier type II) has yet to be defined. The aim of this systematic review was to identify factors associated with improved patient outcomes.
METHODS
Systematic review of studies that described the management of Neimeier type II perforation, reported complications of the first intervention, necessity of added interventions, resolution of the pathology, and days of hospital stay were included. The search strategy was conducted in EMBASE, Mayo Journals, MEDLINE, SCOPUS, and Web of Science (December 2020) RESULTS: A total of 122 patients (53% male) from case reports, series, and cohorts were included for analysis. In total 56 (46%) and 44 (36%)patients were treated with open and laparoscopic cholecystectomy respectively. Overall risk of bias was moderate. The need for another intervention was higher in the laparoscopic group (5 vs 17, p=<0.001) as well as prevalence of complications (4 vs 16, p=<0.001), but lower for days of hospital stay (median days 5. vs 15, p = 0.008) against open cholecystectomy. Preoperative percutaneous catheter drainage did not influence outcome.
CONCLUSION
Open cholecystectomy has a lower need for further surgical procedures and postoperative complications, but a longer hospital stay. These outcomes did not vary with preoperative percutaneous drainage. The effect of timing of cholecystectomy did not influence the outcomes.
Topics: Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Drainage; Female; Gallbladder; Gallbladder Diseases; Humans; Male; Prognosis; Treatment Outcome
PubMed: 34246546
DOI: 10.1016/j.hpb.2021.06.003 -
PloS One 2023Physical harm from Colorectal Cancer Screening tends to be inadequately measured and reported in clinical trials. Also, studies of ongoing Colorectal Cancer Screening... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Physical harm from Colorectal Cancer Screening tends to be inadequately measured and reported in clinical trials. Also, studies of ongoing Colorectal Cancer Screening programs have found more frequent and severe physical harm from screening procedures, e.g., bleeding and perforation, than reported in previous trials. Therefore, the objectives of the study were to systematically review the evidence on the risk of bleeding and perforation in Colorectal Cancer Screening.
DESIGN
Systematic review with descriptive statistics and random-effects meta-analyses.
METHODS
We systematically searched five databases for studies investigating physical harms related to Colorectal Cancer Screening. We assessed the internal and the external validity using the ROBINS-I tool and the GRADE approach. Harm estimates was calculated using mixed Poisson regression models in random-effect meta-analyses.
RESULTS
We included 89 studies. Reporting and measurement of harms was inadequate in most studies. In effect, the risk of bias was critical in 97.3% and serious in 98.3% of studies. All GRADE ratings were very low. Based on severe findings with not-critical risk of bias and 30 days follow-up, the risk of bleedings per 100,000 people screened were 8 [2;24] for sigmoidoscopy, 229 [129;408] for colonoscopy following fecal immunochemical test, 68 [39;118] for once-only colonoscopy, and 698 [443;1045] for colonoscopy following any screening tests. The risk of perforations was 88 [56;138] for colonoscopy following fecal immunochemical test and 53 [25;112] for once-only colonoscopy. There were no findings within the subcategory severe perforation with long-term follow-up for colonoscopy following any screening tests and sigmoidoscopy.
DISCUSSION
Harm estimates varied widely across studies, reporting and measurement of harms was mostly inadequate, and the risk of bias and GRADE ratings were very poor, collectively leading to underestimation of harm. In effect, we consider our estimates of perforation and bleeding as conservative, highlighting the need for better reporting and measurement in future studies.
TRIAL REGISTRATION
PROSPERO registration number: CRD42017058844.
Topics: Humans; Sigmoidoscopy; Early Detection of Cancer; Colorectal Neoplasms; Colonoscopy; Mass Screening; Hemorrhage; Occult Blood
PubMed: 37906565
DOI: 10.1371/journal.pone.0292797 -
Middle East African Journal of... 2017Bacterial keratitis is the most common type among all types of infectious keratitis. Currently, antibiotics are the main-stay of treatment. The objective of this... (Review)
Review
Bacterial keratitis is the most common type among all types of infectious keratitis. Currently, antibiotics are the main-stay of treatment. The objective of this systematic review is to review published clinical studies which discuss the adjunctive treatment of bacterial keratitis to guide clinical decision-making. We reviewed the role of a variety of medications and surgeries which can help in managing bacterial keratitis complications, which include as thinning, perforation, and impaired wound healing. We have included appropriate animal and laboratory studies, case reports and case series, and randomized clinical trials regarding each therapy.
Topics: Anti-Bacterial Agents; Biological Dressings; Cryotherapy; Eye Infections, Bacterial; Humans; Hyperbaric Oxygenation; Keratitis; Surgical Flaps
PubMed: 28546687
DOI: 10.4103/meajo.MEAJO_264_16 -
Plastic and Reconstructive Surgery.... Feb 2018Free-style flaps allow surgeons to overcome anatomical variations and raise perforator flaps wherever a pulsatile signal can be detected. We performed a systematic...
BACKGROUND
Free-style flaps allow surgeons to overcome anatomical variations and raise perforator flaps wherever a pulsatile signal can be detected. We performed a systematic review and meta-analysis to identify the risk factors for complications and indications for free-style flaps in soft-tissue defect reconstructions.
METHODS
This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The databases of MEDLINE, PubMed, ScienceDirect, and Cochrane Library were searched from January 1991 to January 2017 for original articles describing free-style flaps in soft-tissue defect reconstruction.
RESULTS
A total of 17 articles met the inclusion criteria, representing 453 free-style flaps. The percentage of free-style flaps conducted after primary oncologic resection was 54.4% (246/453). Free-style flaps were mostly used in the head and neck region (35.5%), and most of them were designed as pedicled perforator flaps (96.7%). Complete flap survival was accomplished in 91.8% of the free-style flaps. Complications were found in 13.5% of cases, and 2 risk factors were identified: extremity defects (risk ratio, 2.39; = 0.006) and single perforator flaps (risk ratio, 4.93; = 0.002). No significant differences were found among the criteria including patients aged greater than 60 years, female gender, chronic etiology, flap size over 100 cm, flap rotation, or perforator skeletonization.
CONCLUSIONS
Free-style flaps are both reliable and advanced forms of perforator flaps for use in soft-tissue defect reconstructions. Defects located on the extremities and flaps with single perforators are risk factors for flap failure and complications.
PubMed: 29616165
DOI: 10.1097/GOX.0000000000001651 -
Nutrients Sep 2022Necrotizing enterocolitis (NEC) is the most devastating gastrointestinal emergency in preterm neonates. Research on early predictive biomarkers is fundamental. This is a... (Review)
Review
Necrotizing enterocolitis (NEC) is the most devastating gastrointestinal emergency in preterm neonates. Research on early predictive biomarkers is fundamental. This is a systematic review of studies applying untargeted metabolomics and gut microbiota analysis to evaluate the differences between neonates affected by NEC (Bell’s stage II or III), and/or by spontaneous intestinal perforation (SIP) versus healthy controls. Five studies applying metabolomics (43 cases, 95 preterm controls) and 20 applying gut microbiota analysis (254 cases, 651 preterm controls, 22 term controls) were selected. Metabolomic studies utilized NMR spectroscopy or mass spectrometry. An early urinary alanine/histidine ratio >4 showed good sensitivity and predictive value for NEC in one study. Samples collected in proximity to NEC diagnosis demonstrated variable pathways potentially related to NEC. In studies applying untargeted gut microbiota analysis, the sequencing of the V3−V4 or V3 to V5 regions of the 16S rRNA was the most used technique. At phylum level, NEC specimens were characterized by increased relative abundance of Proteobacteria compared to controls. At genus level, pre-NEC samples were characterized by a lack or decreased abundance of Bifidobacterium. Finally, at the species level Bacteroides dorei, Clostridium perfringens and perfringens-like strains dominated early NEC specimens, whereas Clostridium butyricum, neonatale and Propionibacterium acnei those at disease diagnosis. Six studies found a lower Shannon diversity index in cases than controls. A clear separation of cases from controls emerged based on UniFrac metrics in five out of seven studies. Importantly, no studies compared NEC versus SIP. Untargeted metabolomics and gut microbiota analysis are interrelated strategies to investigate NEC pathophysiology and identify potential biomarkers. Expression of quantitative measurements, data sharing via biorepositories and validation studies are fundamental to guarantee consistent comparison of results.
Topics: Alanine; Biomarkers; Enterocolitis, Necrotizing; Gastrointestinal Microbiome; Histidine; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Metabolome; RNA, Ribosomal, 16S
PubMed: 36145235
DOI: 10.3390/nu14183859