Capsulectomy, Implant Exchange, and Placement of Acellular Dermal Matrix is Effective in Treating Capsular Contracture in Breast Augmentation Patients
BACKGROUND: Capsular contracture is a common complication of breast augmentation surgery and many techniques to prevent and to treat capsular contracture have been suggested with inconsistent or variably effective results. OBJECTIVES: The authors describe a protocol for treating established capsular contracture after breast augmentation with a low recurrence rate. METHODS: From January 2009 to December 2012, 79 previous bilateral breast augmentation patients presented for treatment of established capsular contracture. There were 135 breasts with capsular contracture: 56 were bilateral and 23 were unilateral. Ten patients opted for no treatment; two patients opted for implant removal. Twenty-four were treated with the ICES (Implant exchange, Capsulectomy, and possible Exchange of Site) protocol and 43 were treated with the SPICES (Strattice Placement in the reconstructive position, Implant exchange, Capsulectomy, and possible Exchange of Site) protocol. RESULTS: The 24 patients treated with the ICES protocol had a recurrent capsular contracture rate of 15%. The 43 patients treated with the SPICES protocol had a 2.7% recurrent capsular contracture incidence and an 2.7% complication rate. CONCLUSIONS: Capsular contracture after breast augmentation, whether primary or recurrent, can be successfully treated with the SPICES protocol.
Wagner Douglas S; Mirhaidari Shayda
Aesthetic Surgery Journal
2019
2019-12-12
Journal Article
<a href="http://doi.org/10.1093/asj/sjz358" target="_blank" rel="noreferrer noopener">10.1093/asj/sjz358</a>
PMID: 31826242
Pancreatoduodenectomy in patient with perforated duodenal diverticulum and peritonitis: Case report
INTRODUCTION: Duodenal diverticula are quite prevalent in general population, seen on up to 5% of radiology studies and up to 22% of autopsy examinations. PRESENTATION OF THE CASE: 70 years old female was admitted to the hospital with epigastric pain, fevers and elevated white cell count. Abdominal CT scan demonstrated evidence of perforated duodenal diverticulitis which failed to improve with IV antibiotics. Emergent pancreatoduodenectomy was performed with full recovery and uncomplicated hospital stay. DISCUSSIONS: Conservative therapy with antibiotics and bowel rest is successful in majority cases of perforation. Failure of conservative therapy demands surgical management. Variety of surgical approaches ranging from simple diverticulectomy to segmental resection, duodenal exclusion/bypass to pancreatoduodenectomy are available. CONCLUSION: Pancreatoduodenectomy is an option when complicated duodenal diverticulum is not resolved with conservative or interventional therapy. This report has been written in concordance with the SCARE criteria Agha et al. [1]. (C) 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
Philip Justus; Cocieru Andrei
International Journal Of Surgery Case Reports
2019
2019
Journal Article
<a href="http://doi.org/10.1016/j.ijscr.2019.04.011" target="_blank" rel="noreferrer noopener">10.1016/j.ijscr.2019.04.011</a>
Impact of the Optiwave Refractive Analysis in Post-LASIK Patients Undergoing Cataract Surgery
Yalamanchili Siri; Parikh Ankur A; Gemmel David; Erzurum Sergul
Investigative Ophthalmology & Visual Science
2019
2019-07
Journal Article
<a href="https://iovs.arvojournals.org/article.aspx?articleid=2742298" target="_blank" rel="noreferrer noopener">https://iovs.arvojournals.org/article.aspx?articleid=2742298</a>
Dehydrated Extracellular Membranes in the Treatment of Severe Dry Eye
Parikh Ankur A; Yalamanchili Siri; Gemmel David; Erzurum Sergul
Investigative Ophthalmology & Visual Science
2019
2019-07
Journal Article
<a href="https://iovs.arvojournals.org/article.aspx?articleid=2745672" target="_blank" rel="noreferrer noopener">https://iovs.arvojournals.org/article.aspx?articleid=2745672</a>
Clinical and Electrophysiological Outcomes After Eye Muscle Surgery in 81 Adults with Infantile Nystagmus Syndrome (INS)
Hertle Richard W; Curtiss Molly; Ricker Isabel; Ghering Alyssa
Investigative Ophthalmology & Visual Science
2019
2019-07
Journal Article
<a href="http://doi.org/10.1016/j.jaapos.2019.08.111" target="_blank" rel="noreferrer noopener">10.1016/j.jaapos.2019.08.111</a>
1790: WARFARIN TRAUMA PATIENTS: COMPARING PROTHROMBIN COMPLEX CONCENTRATE TO VITAMIN K/FRESH FROZEN PLASMA.
WARFARIN; VITAMIN K; GLASGOW Coma Scale; INTERNATIONAL normalized ratio; PROTHROMBIN
B Learning Objectives: b There is scant data comparing Prothrombin Complex Concentrate (PCC) to Vitamin K/Fresh Frozen Plasma (FFP) in trauma patients. Patients that received PCC (PCC group) were compared to those who received Vitamin K/FFP (FFP group). [Extracted from the article]
Huang Gregory; Hileman Barbara; Chance Elisha; Gianetti Emily; Steiner Dena; Marchand Tiffany
Critical Care Medicine
2019
2019-01-02
Journal Article
<a href="http://doi.org/10.1097/01.ccm.0000552528.13105.55" target="_blank" rel="noreferrer noopener">10.1097/01.ccm.0000552528.13105.55</a>
THE OHIO & KENTUCKY ASMBS STATE CHAPTER: Building on Past History and Recent Success.
OHIO; BARIATRIC surgery; KENTUCKY; NON-insulin-dependent diabetes
Dan Adrian G; Daigle Christopher
Bariatric Times
2019
2019-01
Journal Article
n/a
Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action
Biomarker; Chronic pain; Complex regional pain syndrome; Failed back surgery syndrome; Mechanisms of action; Neuroinflammation; Neuropathic pain; Neurophysiology; Objective measures; Spinal cord stimulation
Well-established in the field of bioelectronic medicine, Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions. Chronic pain is a widely heterogenous syndrome with regard to both pathophysiology and the resultant phenotype. Despite advances in our understanding of SCS-mediated antinociception, there still exists limited evidence clarifying the pathways recruited when patterned electric pulses are applied to the epidural space. The rapid clinical implementation of novel SCS methods including burst, high frequency and dorsal root ganglion SCS has provided the clinician with multiple options to treat refractory chronic pain. While compelling evidence for safety and efficacy exists in support of these novel paradigms, our understanding of their mechanisms of action (MOA) dramatically lags behind clinical data. In this review, we reconstruct the available basic science and clinical literature that offers support for mechanisms of both paresthesia spinal cord stimulation (P-SCS) and paresthesia-free spinal cord stimulation (PF-SCS). While P-SCS has been heavily examined since its inception, PF-SCS paradigms have recently been clinically approved with the support of limited preclinical research. Thus, wide knowledge gaps exist between their clinical efficacy and MOA. To close this gap, many rich investigative avenues for both P-SCS and PF-SCS are underway, which will further open the door for paradigm optimization, adjunctive therapies and new indications for SCS. As our understanding of these mechanisms evolves, clinicians will be empowered with the possibility of improving patient care using SCS to selectively target specific pathophysiological processes in chronic pain.
Caylor Jacob; Reddy Rajiv; Yin Sopyda; Cui Christina; Huang Mingxiong; Huang Charles; Ramesh Rao; Baker Dewleen G; Simmons Alan; Souza Dmitri; Narouze Samer; Vallejo Ricardo; Lerman Imanuel
Bioelectronic Medicine
2019
2019-06
<a href="http://doi.org/10.1186/s42234-019-0023-1" target="_blank" rel="noreferrer noopener">10.1186/s42234-019-0023-1</a>
Policies and practice regarding pregnancy and maternity leave: An international survey
Career advancement; International surgeon; Maternity leave; Pregnancy; Women surgeon
BACKGROUND: As women become a larger part of the surgical workforce, policies surrounding maternity and parental leave play a role in professional practice. Little is known about leave policies worldwide. METHODS: A de novo survey distributed internationally to women surgeons assessed leave polices for surgeons, inclusive of the regulatory body or source of applicable policies, changes in surgical practice due to pregnancy, and duration of leave for both parents. RESULTS: The 1111 survey respondents in 53 different countries describe diverse policies ranging from loss of operating room privileges early in pregnancy to maintenance of full surgical schedules until term delivery. Policy creators include national governments (42.38%), employers/hospitals (60.46%), supervisors (18.06%). Self-determined (9.12%), and unknown (8.7%). Paid parental leave was available to 64.44% of women surgeons and 38.68% of partners. CONCLUSION: Maternity and parental leave policies vary markedly across the global surgical workforce with implications for professional practice.
Walsh Danielle S; Gantt Nancy L; Irish William; Sanfey Hilary A; Stein Sharon L
American Journal of Surgery
2019
2019-07
<a href="http://doi.org/10.1016/j.amjsurg.2019.07.009" target="_blank" rel="noreferrer noopener">10.1016/j.amjsurg.2019.07.009</a>
Laparoscopic Inguinal Hernia Repair Using ProGrip Self-Fixating Mesh: Technical Learning Curve and Mid-Term Outcomes
PURPOSE: Self-fixating mesh has been introduced to further improve the quality results already seen with laparoscopic inguinal hernia repair. An observational study was undertaken to evaluate the technical learning curve and mid-term outcomes associated with the use of ProGrip (Medtronic, Minneapolis, MN, USA) laparoscopic self-fixating mesh in transabdominal preperitoneal (TAPP) inguinal herniorrhaphy. METHODS: Patients who underwent elective laparoscopic TAPP inguinal herniorrhaphy by a single surgeon using ProGrip laparoscopic self-fixating mesh within a one-year period were studied. The primary outcome measures included the time from mesh introduction to the final position (MI-FP), surgical complications, and pain scores. Demographic and other perioperative outcome data were collected and analyzed. RESULTS: Forty hernias were repaired in 29 patients with a laparoscopic TAPP approach. The average MI-FP was 249.4 seconds for the first 20 repairs, and 118.6 seconds (p < 0.001) for the final 20. Minor post-operative surgical complications were reported by 13.8% of patients; there were no major surgical complications. The average pain score on a scale of 0 to 5 was 0.9 (SD = 0.67, range 0-3). CONCLUSIONS: Surgeons with reasonable laparoscopic experience can expect to become fully proficient in the manipulation of self-fixating mesh after 15 to 20 repairs. Use of this product yielded low intraoperative and mid-term postoperative complication rates as well as low postoperative pain.
Mellert Logan T; Cheung Maureen E; Zografakis John G; Dan Adrian G
Surgical Technology International
2019
2019-05
<span>PMID:30753740</span>
Report on Three Porcine Proof-of-concept Studies: Comparison of a Dermatome With a Rotating Excision Ring With Conventional Dermatomes for the Harvesting of Split Skin Grafts and Excision of Necrosis
INTRODUCTION: A new pneumatic dermatome with a circular excision blade was designed to improve a number of disadvantages of regular dermatomes. OBJECTIVE: This study analyzes the safety and efficacy of a new dermatome (test device) for the tangential excision of necrosis and harvesting of split-thickness skin grafts (STSGs). MATERIALS AND METHODS: Three porcine proof-of-concept studies were conducted to compare the test dermatome with conventional dermatomes (control devices) for both excision of necrosis (one study) and the harvesting of a STSG (2 studies). For the harvesting studies, donor sites and grafts were analyzed for viability, healing rate, and scar outcomes. Biomechanical tests also were performed on the donor sites. For the necrotectomy study, healing of the excised area and thickness of the excised tissues were studied. RESULTS: The test device was similar to the control devices in viability of collected tissues, speed of healing, and donor site biomechanics. In 1 graft harvesting study, as well as in the excision study, uniformity of the thickness of the harvested tissues was better for the test device than for the control devices. The test device performed better than the controls on maneuverability, control of the consistency of the relationship between depth setting and actual graft thickness, device assembly, overall ease of use, depth of the debridement as intended, consistency of the debridement thickness, device accuracy, and size. CONCLUSIONS: The studies showed the test device, when compared with the control devices, was equal on safety. On efficacy, consistency of the excised tissues was superior for the test device, which may result in better grafts and outcomes. Several aspects related to the ease of use, particularly maneuverability, were superior as well.
Hermans Michel He; Pittinger Tim; Bailey Kevin; Powell Heather M
Wounds: A Compendium of Clinical Research and Practice
2019
2019-06
<a href="https://www.woundsresearch.com/article/report-three-porcine-proof-concept-studies-comparison-dermatome-rotating-excision-ring" target="_blank" rel="noreferrer noopener">https://www.woundsresearch.com/article/report-three-porcine-proof-concept-studies-comparison-dermatome-rotating-excision-ring</a>
A smart decision: smartphone use for operative data collection in arthroscopic shoulder instability surgery
electronic medical record; information standardization; outcomes; shoulder instability; smartphone
OBJECTIVE: This study tested validity, accuracy, and efficiency of the Orthopaedic Minimal Data Set Episode of Care (OME) compared with traditional operative report in arthroscopic surgery for shoulder instability. As of November 2017, OME had successfully captured baseline data on 97% of 18 700 eligible cases. MATERIALS AND METHODS: This study analyzes 100 cases entered into OME through smartphones by 12 surgeons at an institution from February to October 2015. A blinded reviewer extracted the same variables from operative report into a separate database. Completion rates and agreement were compared. They were assessed using raw percentages and McNemar's test (with continuity correction). Agreement between nominal variables was assessed by unweighted Cohen's kappa and a concordance correlation coefficient measured agreement between continuous variables. Efficiency was assessed by median time to complete. RESULTS: Of 37 variables, OME demonstrated equal or higher completion rates for all but 1 and had significantly higher capture rates for 49% (n = 18; P < .05). Of 33 nominal variables, raw proportional agreement was ≥0.90 for 76% (n = 25). Raw proportional agreement was perfect for 15% (n = 5); no agreement statistic could be calculated due to a single variable in operative note and OME. Calculated agreement statistic was substantial or better (κ > 0.61) for 51% (n = 17) for the 33 nominal variables. All continuous variables assessed (n = 4) demonstrated poor agreement (concordance correlation coefficient <0.90). Median time for completing OME was 103.5 (interquartile range, 80.5-151) seconds. CONCLUSIONS: The OME smartphone data capture system routinely captured more data than operative report and demonstrated acceptable agreement for nearly all nominal variables, yet took <2 minutes to complete on average.
Mohr Jill; Strnad Gregory J; Farrow Lutul; Heinlein Kate; Hettrich Carolyn M; Jones Morgan; Miniaci Anthony; Ricchetti Eric; Rosneck James; Schickendantz Mark; Saluan Paul; Vega Jose F; Spindler Kurt P; Group Cleveland Clinic O M E Sports Health
Journal of the American Medical Informatics Association: JAMIA
2019
2019-06
<a href="http://doi.org/10.1093/jamia/ocz074" target="_blank" rel="noreferrer noopener">10.1093/jamia/ocz074</a>
Effectiveness of computed tomography scanning to detect blunt bowel and mesenteric injuries requiring surgical intervention: A systematic literature review
Abdominal computed tomography; Computed tomography performance; Diagnostic accuracy; Hollow viscus injury; Mesenteric injury
BACKGROUND: Computed tomography (CT) diagnostic accuracy for blunt bowel and mesenteric injuries (BBMI) is controversial. DATA SOURCES: A literature review to compute aggregate CT performance and individual CT sign sensitivity, specificity, and positive predictive value (PPV) for operative BBMI. CONCLUSIONS: Sensitivity, specificity, and PPV were: overall CT performance 85.3%, 96.1%, 51.4%; abnormal wall enhancement 30.1%, 95.7%, 64.0%; bowel wall discontinuity 22.3%, 99.0%, 87.9%; bowel wall hematoma 22.5%, 100%, 19.5%; bowel wall thickening 35.2%, 96.5%, 32.1%; free air 32.0%, 98.7%, 57.1%; free fluid 65.6%, 85.0%, 25.5%; mesenteric air 27.6%, 99.1%, 85.3%; mesenteric extravasation 22.9%, 99.6%, 73.9%; mesenteric hematoma/fluid 33.9%, 98.7%, 52.8%; mesenteric stranding/streaking 34.3%, 91.8%, 31.6%; mesenteric vessel beading 32.1%, 97.2%, 60.4%; mesenteric vessel termination 31.6%, 97.2%, 63.5%; oral contrast extravasation 10.0%, 100%, 100%; retroperitoneal air 9.4%, 94.9%, 55.6%; and retroperitoneal fluid 44.2%, 49.4%, 38.5%. Sensitivity, specificity, and PPV vary substantially among known signs. Other clinical factors are necessary for comprehensive BBMI identification.
Abdel-Aziz Hiba; Dunham C Michael
American Journal of Surgery
2019
2019-07
<a href="http://doi.org/10.1016/j.amjsurg.2018.08.018" target="_blank" rel="noreferrer noopener">10.1016/j.amjsurg.2018.08.018</a>
Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; A collaboration from the American Association for the Surgery of Trauma Patient Assessment Committee, the American Association for the Surgery of Trauma Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee.
BACKGROUND: Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients. METHODS: A priori questions were created regarding outcomes for patients 65 years or older with respect to care at trauma centers versus nontrauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and EMBASE was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to perform a systematic review and create recommendations. RESULTS: We reviewed seven articles relevant to trauma center care and nine articles reporting results on palliative care processes as they related to geriatric trauma patients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric trauma patients but are unable to make a recommendation on the question of routine palliative care processes for geriatric trauma patients. CONCLUSIONS: As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric trauma patients in most studies and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay; however, inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma. LEVEL OF EVIDENCE: Systematic review/guideline, level III.
Aziz Hiba Abdel; Lunde John; Barraco Robert; Como John J; Cooper Zara; Hayward Thomas 3rd; Hwang Franchesca; Lottenberg Lawrence; Mentzer Caleb; Mosenthal Anne; Mukherjee Kaushik; Nash Joshua; Robinson Bryce; Staudenmayer Kristan; Wright Rebecca; Yon James; Crandall Marie
The journal of trauma and acute care surgery
2019
2019-04
<a href="http://doi.org/10.1097/TA.0000000000002155" target="_blank" rel="noreferrer noopener">10.1097/TA.0000000000002155</a>
Laparoscopic Inguinal Hernia Repair Using ProGrip Self-Fixating Mesh: Technical Learning Curve and Mid-Term Outcomes.
PURPOSE: Self-fixating mesh has been introduced to further improve the quality results already seen with laparoscopic inguinal hernia repair. An observational study was undertaken to evaluate the technical learning curve and mid-term outcomes associated with the use of ProGrip (Medtronic, Minneapolis, MN, USA) laparoscopic self-fixating mesh in transabdominal preperitoneal (TAPP) inguinal herniorrhaphy. METHODS: Patients who underwent elective laparoscopic TAPP inguinal herniorrhaphy by a single surgeon using ProGrip laparoscopic self-fixating mesh within a one-year period were studied. The primary outcome measures included the time from mesh introduction to the final position (MI-FP), surgical complications, and pain scores. Demographic and other perioperative outcome data were collected and analyzed. RESULTS: Forty hernias were repaired in 29 patients with a laparoscopic TAPP approach. The average MI-FP was 249.4 seconds for the first 20 repairs, and 118.6 seconds (p \textless 0.001) for the final 20. Minor post-operative surgical complications were reported by 13.8% of patients; there were no major surgical complications. The average pain score on a scale of 0 to 5 was 0.9 (SD = 0.67, range 0-3). CONCLUSIONS: Surgeons with reasonable laparoscopic experience can expect to become fully proficient in the manipulation of self-fixating mesh after 15 to 20 repairs. Use of this product yielded low intraoperative and mid-term postoperative complication rates as well as low postoperative pain.
Mellert Logan T; Cheung Maureen E; Zografakis John G; Dan Adrian G
Surgical technology international
2019
2019-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Clinical and electrophysiological results of eye muscle surgery in 17 patients with downbeat nystagmus.
Downbeat nystagmus; eye muscle surgery; vision rehabilitation
Purpose: To test the hypothesis that eye muscle surgery in treatment of patients with acquired downbeat nystagmus results in improvement measures of visual and ocular motor function. Methods: This is a prospective, interventional case series analysis of clinical and electrophyisological data before and after eye muscle surgery in 17 patients with acquired downbeat nystagmus who did not respond to medical treatments. Outcome measures included: 1) routine demography and clinical characteristics, 2) subjective oscillopsia (SO), 3) binocular best-corrected visual acuity in the null position (BVA), 3) primary position strabismic deviation (SD), 5) anomalous head posture (AHP), 6) contrast sensitivity function (CS), and 7) nystagmus slow phase velocity (SPV). All patients were followed at least 12 months. Parametric and non-parametric statistical analysis of outcome measure data above pre- and post-treatment were perfomed using standard software on grouped data using computerized software. Results: Patients' age ranged from 5 to 85 years (average 27 years). About 59% were male. Follow up ranged from 1-10 years (average 2.0 years). Around 70% had an associated central nervous systemic diagnosis, 100% had an AHP, oscillopsia and decreased CS, 53% had other eye disease, and 59% had strabismus. There were no complications from surgery. There were signficant post-treatment improvements in mean/median group BVA, SO, SD, AHP, CS, and SPV. Conclusion: This study supports the hypothesis that eye muscle surgery as treatments for patients with acquired downbeat nystagmus can result in improvements in multiple aspects of ocular motor and visual functions.
Hertle Richard W; Ahmad Ashraf
Indian journal of ophthalmology
2019
2019-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4103/ijo.IJO_703_18" target="_blank" rel="noreferrer noopener">10.4103/ijo.IJO_703_18</a>