Hasil untuk "Surgery"

G. W. Smith, R. Robinson

M. Makuuchi, Thai Bl, K. Takayasu et al.

M. Mudge, L. Hughes

A. Stout, M. R. Murray

D. Sutherland, R. Olshen, L. Cooper et al.

A. Sidawy, R. Gray, A. Besarab et al.

The incidence rate of treated end-stage renal disease in the united states is 180 per million and continues to rise at a rate of 7.8% per year. Arteriovenous hemodialysis access (AV access) creation and maintenance are two of the most difficult issues associated with the management of patients on hemodialysis. The 1-year complication rate of a primary prosthetic AV access for hemodialysis ranges from 33% to 99%. Various investigators report on patency and complications of AV access. However, it is rather difficult to compare outcomes because of the wide variety of access materials, configurations, locations, risk factors, and quality of inflow and outflow vessels. Although there have been reporting standards for dialysis access endovascular interventions and for central venous access placement, standards regarding surgical access placement and its revision are lacking. The "Dialysis Outcome Quality Initiative," published by the National Kidney Foundation, provides recommendations for optimal clinical practices aimed at improving dialysis outcome and patient survival. This reporting standards document is not meant to be a "practice guidelines" or "best practices" document. Rather, the purpose of this document is to provide standardized definitions related to AV access procedures and to recommend reporting standards for patency and complications, to be used by surgeons, nephrologists, and interventional radiologists, that will permit meaningful comparisons among AV access procedures. The terms, definitions, and categories featured in this article have been approved by the Committee on Reporting Standards of the Society for Vascular Surgery and the American Association for Vascular Surgery and should be observed in preparing manuscripts on AV accesses for submission to the Journal Of Vascular Surgery.

F. Niessen, P. Spauwen, J. Schalkwijk et al.

M. Büchler, B. Gloor, C. Müller et al.

M. Griesser, Joshua D. Harris, Brett W. McCoy et al.

A. Almazan, A. Keuroghlian

Importance Requests for gender-affirming surgeries are rapidly increasing among transgender and gender diverse (TGD) people. However, there is limited evidence regarding the mental health benefits of these surgeries. Objective To evaluate associations between gender-affirming surgeries and mental health outcomes, including psychological distress, substance use, and suicide risk. Design, Setting, and Participants In this study, we performed a secondary analysis of data from the 2015 US Transgender Survey, the largest existing data set containing comprehensive information on the surgical and mental health experiences of TGD people. The survey was conducted across 50 states, Washington, DC, US territories, and US military bases abroad. A total of 27 715 TGD adults took the US Transgender Survey, which was disseminated by community-based outreach from August 19, 2015, to September 21, 2015. Data were analyzed between November 1, 2020, and January 3, 2021. Exposures The exposure group included respondents who endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses. The comparison group included respondents who endorsed a desire for 1 or more types of gender-affirming surgery but denied undergoing any gender-affirming surgeries. Main Outcomes and Measures Endorsement of past-month severe psychological distress (score of ≥13 on Kessler Psychological Distress Scale), past-month binge alcohol use, past-year tobacco smoking, and past-year suicidal ideation or suicide attempt. Results Of the 27 715 respondents, 3559 (12.8%) endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses, while 16 401 (59.2%) endorsed a desire to undergo 1 or more types of gender-affirming surgery but denied undergoing any of these. Of the respondents in this study sample, 16 182 (81.1%) were between the ages of 18 and 44 years, 16 386 (82.1%) identified as White, 7751 (38.8%) identified as transgender women, 6489 (32.5%) identified as transgender men, and 5300 (26.6%) identified as nonbinary. After adjustment for sociodemographic factors and exposure to other types of gender-affirming care, undergoing 1 or more types of gender-affirming surgery was associated with lower past-month psychological distress (adjusted odds ratio [aOR], 0.58; 95% CI, 0.50-0.67; P < .001), past-year smoking (aOR, 0.65; 95% CI, 0.57-0.75; P < .001), and past-year suicidal ideation (aOR, 0.56; 95% CI, 0.50-0.64; P < .001). Conclusions and Relevance This study demonstrates an association between gender-affirming surgery and improved mental health outcomes. These results contribute new evidence to support the provision of gender-affirming surgical care for TGD people.

K. Kondo, Y. Monden

B. Atkins, N. Athanasou, J. Deeks et al.

MD Pierre Tibi, M. F. R. Scott McClure, MD Jiapeng Huang et al.

R. Arriagada, A. Aupérin, S. Burdett et al.

Summary Background Many randomised controlled trials have investigated the effect of adjuvant chemotherapy in operable non-small-cell lung cancer. We undertook two comprehensive systematic reviews and meta-analyses to establish the effects of adding adjuvant chemotherapy to surgery, or to surgery plus radiotherapy. Methods We included randomised trials, not confounded by additional therapeutic differences between the two groups and that started randomisation on or after Jan 1, 1965, which compared surgery plus adjuvant chemotherapy versus surgery alone, or surgery plus adjuvant radiotherapy and chemotherapy versus surgery plus adjuvant radiotherapy. Updated individual patient data were collected, checked, and included in meta-analyses stratified by trial. The primary endpoint was overall survival, defined as time from randomisation until death by any cause. All analyses were by intention to treat. Findings The first meta-analysis of surgery plus chemotherapy versus surgery alone was based on 34 trial comparisons and 8447 patients (3323 deaths). We recorded a benefit of adding chemotherapy after surgery (hazard ratio [HR] 0·86, 95% CI 0·81–0·92, p<0·0001), with an absolute increase in survival of 4% (95% CI 3–6) at 5 years (from 60% to 64%). The second meta-analysis of surgery plus radiotherapy and chemotherapy versus surgery plus radiotherapy was based on 13 trial comparisons and 2660 patients (1909 deaths). We recorded a benefit of adding chemotherapy to surgery plus radiotherapy (HR 0·88, 95% CI 0·81–0·97, p=0·009), representing an absolute improvement in survival of 4% (95% CI 1–8) at 5 years (from 29% to 33%). In both meta-analyses we noted little variation in effect according to the type of chemotherapy, other trial characteristics, or patient subgroup. Interpretation The addition of adjuvant chemotherapy after surgery for patients with operable non-small-cell lung cancer improves survival, irrespective of whether chemotherapy was adjuvant to surgery alone or adjuvant to surgery plus radiotherapy. Funding UK Medical Research Council, Institut Gustave-Roussy, Programme Hospitalier de Recherche Clinique (AOM 05 209), Ligue Nationale Contre le Cancer, and Sanofi-Aventis.

J. Weinstein, J. Lurie, T. Tosteson et al.

O. Farges, J. Belghiti, R. Kianmanesh et al.

D. Magro, B. Geloneze, R. Delfini et al.

C. Gutt, J. Encke, J. Köninger et al.

Zaid Al-Ishaq, Suad AlAghbari, Samiya Al Hattali et al.

Background: Phyllodes tumors (PT) are rare fibroepithelial neoplasms of the breast that represent 0.3% to 1% of all primary breast tumors and may occur in benign, borderline or malignant forms. Objectives: To describe the clinical characteristics, surgical management, and outcomes of PT treated at a tertiary center in Oman. Materials and Methods: A retrospective review of all PT cases managed between 2011 and 2024 at the Breast Program of Sultan Qaboos Comprehensive Cancer Care and Research Centre/University Medical City was conducted. Demographic, pathological, surgical, adjuvant treatment, and outcome data were analyzed. Results: Seventeen Omani women were identified. Histological subtypes included malignant in 9 patients (52.9%), borderline in 6 (35.2%), and benign in 2 (11.7%). Breast-conserving surgery was performed in 13 patients (76.4%); 9 required re-excision for margin clearance, and 1 declined further surgery. Axillary staging was performed in 8 patients (47.1%) due to clinically suspicious nodes, with no pathological involvement detected. Adjuvant radiotherapy was administered to 3 patients (17.6%) with malignant PT. During a mean follow-up of 5.4 years (range 1-13 years), local recurrence occurred in 2 patients (11.7%) and distant metastases in 4 patients (23.5%). Conclusions: PT in this cohort frequently required margin re-excision, highlighting the importance of maintaining a high index of suspicion, integrating oncoplastic surgical techniques, and adopting a multidisciplinary management approach. Selective axillary assessment based on preoperative evaluation and multidisciplinary discussion may help minimize unnecessary axillary surgery.

Alfredo Moreno-Egea, Carlos Moreno-Latorre, Alfredo Moreno-Latorre

Background: The history of radical hernia repair involves a period of intense surgical activity, influenced by factors of the time such as social development, hygiene, anesthesia, and antisepsis. Subcutaneous surgery, the initial option designed to avoid infections and peritonitis, was modified after the introduction of antisepsis, eventually leading to dissection surgery. Objective: We aim to analyze the publications from the period of radical hernia cures using current methodology, verifying when and how the transition occurred from subcutaneous surgery to dissection surgery. Methods: A literature review of the databases PubMed, LILACS, Cochrane Library, “Google” and university libraries is conducted. The following keywords were used: “anatomy and surgery”. A critical analysis of the known literature about this historical topic is carried out. Results: Under-vision dissection surgery, through incision of the aponeurosis of the external oblique muscle, began in England by Durham in 1866, almost 20 years before it was performed in France by Lucas-Championnière in 1885. Recurrences decreased after the introduction of the principle of closing the walls of the inguinal canal (Wood, 1860). The surgeon–anatomist Wood should be considered the first specialist in abdominal wall surgery, due to his extensive contributions from the pre-antiseptic era. The evolution of the radical cure of hernias was made possible by combining the knowledge of several countries: England, Germany, and Italy. Conclusions: Dissection surgery was initiated in England, Germany, and Italy, not in France. The influence of the French literature on the history of hernias is evident, to the detriment of the contributions of surgeons from other countries.