Hasil untuk "Surgery"

J. Popma, Michael G. Deeb, S. Yakubov et al.

BACKGROUND Transcatheter aortic‐valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low‐risk patients. METHODS We performed a randomized noninferiority trial in which TAVR with a self‐expanding supraannular bioprosthesis was compared with surgical aortic‐valve replacement in patients who had severe aortic stenosis and were at low surgical risk. When 850 patients had reached 12‐month follow‐up, we analyzed data regarding the primary end point, a composite of death or disabling stroke at 24 months, using Bayesian methods. RESULTS Of the 1468 patients who underwent randomization, an attempted TAVR or surgical procedure was performed in 1403. The patients' mean age was 74 years. The 24‐month estimated incidence of the primary end point was 5.3% in the TAVR group and 6.7% in the surgery group (difference, ‐1.4 percentage points; 95% Bayesian credible interval for difference, ‐4.9 to 2.1; posterior probability of noninferiority >0.999). At 30 days, patients who had undergone TAVR, as compared with surgery, had a lower incidence of disabling stroke (0.5% vs. 1.7%), bleeding complications (2.4% vs. 7.5%), acute kidney injury (0.9% vs. 2.8%), and atrial fibrillation (7.7% vs. 35.4%) and a higher incidence of moderate or severe aortic regurgitation (3.5% vs. 0.5%) and pacemaker implantation (17.4% vs. 6.1%). At 12 months, patients in the TAVR group had lower aortic‐valve gradients than those in the surgery group (8.6 mm Hg vs. 11.2 mm Hg) and larger effective orifice areas (2.3 cm2 vs. 2.0 cm2). CONCLUSIONS In patients with severe aortic stenosis who were at low surgical risk, TAVR with a self‐expanding supraannular bioprosthesis was noninferior to surgery with respect to the composite end point of death or disabling stroke at 24 months. (Funded by Medtronic; ClinicalTrials.gov number, NCT02701283.)

P. Ramirez, M. Frumovitz, R. Pareja et al.

BACKGROUND There are limited data from retrospective studies regarding whether survival outcomes after laparoscopic or robot‐assisted radical hysterectomy (minimally invasive surgery) are equivalent to those after open abdominal radical hysterectomy (open surgery) among women with early‐stage cervical cancer. METHODS In this trial involving patients with stage IA1 (lymphovascular invasion), IA2, or IB1 cervical cancer and a histologic subtype of squamous‐cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, we randomly assigned patients to undergo minimally invasive surgery or open surgery. The primary outcome was the rate of disease‐free survival at 4.5 years, with noninferiority claimed if the lower boundary of the two‐sided 95% confidence interval of the between‐group difference (minimally invasive surgery minus open surgery) was greater than ‐7.2 percentage points (i.e., closer to zero). RESULTS A total of 319 patients were assigned to minimally invasive surgery and 312 to open surgery. Of the patients who were assigned to and underwent minimally invasive surgery, 84.4% underwent laparoscopy and 15.6% robot‐assisted surgery. Overall, the mean age of the patients was 46.0 years. Most patients (91.9%) had stage IB1 disease. The two groups were similar with respect to histologic subtypes, the rate of lymphovascular invasion, rates of parametrial and lymph‐node involvement, tumor size, tumor grade, and the rate of use of adjuvant therapy. The rate of disease‐free survival at 4.5 years was 86.0% with minimally invasive surgery and 96.5% with open surgery, a difference of ‐10.6 percentage points (95% confidence interval [CI], ‐16.4 to ‐4.7). Minimally invasive surgery was associated with a lower rate of disease‐free survival than open surgery (3‐year rate, 91.2% vs. 97.1%; hazard ratio for disease recurrence or death from cervical cancer, 3.74; 95% CI, 1.63 to 8.58), a difference that remained after adjustment for age, body‐mass index, stage of disease, lymphovascular invasion, and lymph‐node involvement; minimally invasive surgery was also associated with a lower rate of overall survival (3‐year rate, 93.8% vs. 99.0%; hazard ratio for death from any cause, 6.00; 95% CI, 1.77 to 20.30). CONCLUSIONS In this trial, minimally invasive radical hysterectomy was associated with lower rates of disease‐free survival and overall survival than open abdominal radical hysterectomy among women with early‐stage cervical cancer. (Funded by the University of Texas M.D. Anderson Cancer Center and Medtronic; LACC ClinicalTrials.gov number, NCT00614211.)

E. Meinberg, J. Agel, C. Roberts et al.

W. V. van Driel, S. Koole, K. Sikorska et al.

M. Reardon, N. Van Mieghem, J. Popma et al.

S. Sakuramoto, M. Sasako, Toshiharu Yamaguchi et al.

M. Güngör, F. Ortaç, M. Arvas et al.

J. Moller, P. Cluitmans, L. Rasmussen et al.

E. Kapiteijn, C. Marijnen, I. D. Nagtegaal et al.

D. Kennedy

Fernando N. Martín Cocilova, Elisabetta Neri, Filippo Nozzoli et al.

Pseudomyogenic hemangioendothelioma (PHME) is a very rare vascular tumor that usually arises in the extremities, mainly cutaneous or subcutaneous, but also occurs in deeper locations, such as muscles and bone. Less than 200 cases have been reported so far, and primary intraosseous PHMEs are further infrequent. We present a clinical case of PMHE of the femur in a young male adult successfully treated by intercalary resection and massive allograft reconstruction with plates fixation. After more than 2 years of follow-up, the patient is disease-free and asymptomatic, walking with full weight-bearing with radiographic evidence of allograft union.

Alexa Clark, BA, Austin Gaal, DDS, MPH, FACS

Summary:. Tessier 0, or midline facial clefts, is one of the most common presentations among craniofacial clefts; however, there may be a diverse severity in presentations. This report applies established methods in bilateral lip repair to an incomplete Tessier 0 presentation. The report reviews literature available on midline facial clefts and contrasts the proposed application with a single straight-line repair. Tessier 0 clefts are rare, with an estimated incidence ranging from 1.4 to 4.9 per 100,000 live births. About 80 cases have been described in the literature; however, these may be underreported. Standard bilateral cheilorhinoplasty techniques previously described may be used for these relatively rare cases. The application of established methods for bilateral cleft lip/nose primary care may be performed for variants of rare facial clefting.

Kian Habashi, Jayme A. Ching, Allison G. McNickle

Introduction: Healthcare providers should ask advance care planning (ACP) questions early, especially in the often frail population of geriatric trauma patients. To improve ACP documentation at our institution, we implemented a smart phrase for use in patients over 60 with hip and/or femur fractures. The smart phrase addresses living situations, patient wishes and pre-existing ACP documents. Methods: We completed a retrospective chart review analyzing the prevalence of ACP documentation, its timing (pre or post-operatively), and the service completing it for 1 year pre- and post-implementation. Results: After smart phrase inception, ACP documentation increased from 23.1 % to 91.7 %. Pre-operative documentation increased from 15.1 % to 90.2 % Trauma service frequency of documentation increased from 20.7 % to 92.3 %. Conclusions: There was a significant improvement of ACP documentation pre-operatively and by the primary trauma team with a smart phrase. This increased knowledge of treatment preferences can provide better informed medical decision-making for a high risk population.

María Cristina Franco-Arellanes, Perla Xóchitl Toledo-Valdes, Cynthia Díaz-Hernández et al.

INTRODUCTION: O-GlcNAcylation is a post-translational modification in which a single N-Acetyl-D-Glucosamine (GlcNAc) molecule is added to Ser or Thr residues of proteins. The O-N-acetylglucosaminyl transferase (OGT) enzyme is responsible for adding GlcNAc to the target proteins and N-acetyl-β-D-glucosaminidase (OGA) that removes the GlcNAc residue. O-GlcNAcylation has been described in the pathophysiology of several diseases; however, little has been studied in dental tissue. The aim of the present work is to characterise the product of O-GlcNAcylation and its enzymes at the tissue level in the dental pulp, as well as its expression in dental pulp stem cells (DPSCs) both in situ and in vitro. This enables the recognition of the behaviour of O-GlcNAcylation in pulp tissue without pathology. MATERIAL AND METHODS: Pulp tissue was obtained from 10 healthy donors, and the expression of O-GlcNAc, OGT, and OGA was analysed using immunofluorescence with specific antibodies in different regions of the dental pulp. DPSCs were isolated, cultured, and identified with anti-STRO1 (antibody specific for human CD34+ cells, useful for DPSC identification). The expression of O-GlcNAc in DPSCs was confirmed in vitro through Western blot. Results. Different regions of the dental pulp and DPSCs express O-GlcNAc and the enzymes OGT and OGA. O-GlcNAc and OGT expression was more prominent in the odontoblastic layer, cell-rich zone, and in the central core. OGA was distributed throughout the pulp tissue with lower immunoreactivity compared to OGT. CONCLUSIONS: Our results suggest that O-GlcNAcylation may play a relevant role in human dental pulp homeostasis and in physiology of DPSCs.

Agathe Yvinou, Romain Alain

Abstract Gender and sex disparities persist in orthopaedic and traumatology surgery, making it one of the least diverse medical specialties worldwide. Despite growing women representation in medical education, women continue to be significantly underrepresented in orthopaedics, occupying only 6–8% of surgical roles. This underrepresentation extends to academic leadership, research, and public speaking opportunities, ultimately limiting innovation and the quality of patient care. Systemic barriers—such as gender bias, lack of mentorship, and misperceptions about physical demands—discourage women from entering and advancing in the field. This manuscript explores the current landscape of gender inequality in orthopaedics and identifies strategic interventions to promote equity. Solutions include enhancing recruitment through early exposure, fostering inclusive institutional cultures, expanding mentorship and sponsorship opportunities, and implementing supportive policies for work-life integration. In patient care, disparities in diagnosis, pain management, surgical decision-making, and rehabilitation access disproportionately impact women. We advocate for the development of gender-inclusive clinical guidelines, equitable research funding, and standardized assessment tools. Additionally, the role of public awareness is examined, emphasizing the need to highlight success stories, engage male allies, and conduct outreach through educational and community initiatives. Programs such as the Perry Initiative, Nth Dimensions, and campaigns like HeForShe are shown to play pivotal roles in shifting perceptions and increasing diversity. Addressing these disparities is not only a matter of justice but also essential to achieving excellence in clinical outcomes. This article offers a comprehensive framework for fostering gender and sex equality in orthopaedic and traumatology surgery through systemic, cultural, and policy-level change.

Qasam M. Ghulam, Jens P. Goetze, Nikolaj Eldrup et al.

Introduction: Abdominal aortic aneurysms (AAAs) with intraluminal thrombus (ILT) are suggested to be more prone to rupture than AAAs without. Prior studies indicate that the von Willebrand factor (vWf) plays a role in the formation of ILT since a positive correlation between ILT volume and vWf has been shown. vWf mediates the tethering of platelets at sites of endothelial injury, and the protease ADAMTS-13 cleaves larger forms of vWf, thus counteracting the thrombosis cascade and maintaining haemostatic balance. When investigating the largest quantifiable thrombus in the human body, it was hypothesised that circulating ADAMTS-13 activity may be associated with ILT size in patients with AAA and the aim was to explore this potential relationship using 3D contrast enhanced ultrasound (3D-CEUS) for ILT volume determination. Report: In this retrospective, exploratory study, 60 patients with AAA were evaluated, and the association between ILT volume and thickness and ADAMTS-13 was estimated using 3D-CEUS. ADAMTS-13 activity was measured in plasma samples obtained the same day. No association between ILT volume (r = −0.03, p = 0.84) or ILT thickness (r = 0.02, p = 0.87) and ADAMTS-13 activity was found. Likewise, when subdividing the group into lowest and highest 50% of ADAMTS-13 activity, the half with the lowest ADAMTS-13 activity (mean ILT volume ±standard deviation [SD]: 32 ± 34 mL) did not differ from the half with the highest ADAMTS-13 activity (43 ± 24 mL) when comparing ILT volume (p = 0.172, F = 2.95) and thickness (p = 0.070). Discussion: After evaluating the largest quantifiable intraluminal thrombus in the vasculature, it was concluded that, surprisingly, circulating ADAMTS-13 activity seems unrelated to ILT formation in AAA.