Neonatal surgery in low- vs. high-volume institutions: a KID inpatient database outcomes and cost study after repair of congenital diaphragmatic hernia, esophageal atresia, and gastroschisis
AbstractBackground/purposeThe volume –outcome relationship and optimal surgical volumes for repair of congenital anomalies in neonates is unknown.MethodsA retrospective study of infants who underwent diaphragmatic hernia (CDH), gastroschisis (GS), and esophageal atresia/tracheoesophageal fistula (EA/TEF) repair at US hospitals using the Kids ’ Inpatient Database 2009–2012. Distribution of institutional volumes was calculated. Multi-level logistic/linear regressions were used to determine the association between volume and mortality, length of stay, and costs.ResultsTotal surgical volumes were 1186 for CDH, 1280 for EA/TEF, and 3372 for GS. Median case volume per institution was three for CDH and EA/TEF, and four for GS. Hospitals with annual case volumes ≥ 75th percentile were considered high volume. Approximately, half of all surgeries were performed at low-volume hospitals. No clinically meaningful association between volume and outcomes was found for any procedure. Median cost was greater at high- vs. low-volume hospitals [CDH: $165,964 (p
This article and accompanying video show the technique and discusses the technical pearls of a latissimus tendon repair using suture button fixation via a single-incision approach.
ConclusionCombined Rendez-vous isthmoplasty is feasible, safe, and effective in experienced hands, giving the surgeon a comprehensive evaluation of the anatomy of the isthmocele, and increasing the odds of a complete resection and restoration of the anatomy 4, 5, 6, 7. In this patient, the procedure was uneventful, without any intra- or postoperative complications, and the symptoms were completely controlled.
Publication date: Available online 25 January 2020Source: Seminars in Cancer BiologyAuthor(s): Nikita Pozdeyev, Madison M. Rose, Daniel W. Bowles, Rebecca E. SchweppeAbstractAnaplastic thyroid cancer (ATC) represents one of the most lethal human cancers and although this tumor type is rare, ATC accounts for the majority of deaths from thyroid cancer. Due to the rarity of ATC, a comprehensive genomic characterization of this tumor type has been challenging, and thus the development of new therapies has been lacking. To date, there is only one mutation-driven targeted therapy for BRAF-mutant ATC. Recent genomic studies have ...
Conclusions: In this initial small series, we found that robot-assisted VVF repair is a safe procedure with results comparable to transvaginal repair. This procedure has a high success rate and few complications without using interposed tissue. PMID: 31975648 [PubMed - as supplied by publisher]
We report the case of a 63 year-old male with an atrioesophageal fistula following ablation who presented with neurologic symptoms and underwent emergent repair. He subsequently sustained a leak from the esophageal repair requiring emergent esophagectomy with end-esophagostomy. After several months, the patient underwent re-establishment of gastrointestinal continuity via retrosternal gastric conduit reconstruction.
We reported an adult patient who developed a cardiocutaneous fistula one year after the third left ventricular aneurysm repair. The patient was successfully treated with a redo operation using bovine pericardial patch with omental flap coverage. He was alive and well 10 years later.
We describe a method which is safe and reproducible.It is not uncommon for the right ventricular perforation to occur during dissection for exposure of intra myocardial left anterior descending artery (LAD) as a part of coronary artery bypass grafting and in unroofing procedure for myocardial bridging.This complication is likely to develop when the dissection is kept to the right side of anterior descending artery. The right ventricular cavity comes closest to the LAD in the intramyocardial portion separated only by thin layer of muscle and endothelium. Several techniques are in vogue for dealing with this potentially seri...
We present a case of a young male that suffered a combined (intra-extraperitoneal) gun shot gun to the rectus and the use of a transanal platform to repair it.ResumoAté 80 % das lesões retais relatadas nos centros de trauma dos EUA ocorrem secundariamente às lesões por armas de fogo. Ferimentos retais por arma de fogo estão associados a significativa morbimortalidade. Foram descritas diversas abordagens e técnicas cirúrgicas; no entanto, ainda há controvérsias quanto qual é o melhor tratamento para essas lesões complexas. Atualmente, nenhuma abord...
We have shown that CCL11 (eotaxin-1), an eosinophil chemoattractant, is significantly increased in the serum of ulcerative colitis and Crohn ’s disease patients vs controls and is also increased in dextran sulfate sodium (DSS)-induced murine colitis. In response to azoxymethane (AOM)-DSS, Ccl11–/– mice have significantly decreased colonic tumor number and burden, histologic injury, and colonic eosinophil infiltration vs wild-type ( WT) mice. Ccl11 is expressed by isolated colonic epithelial and lamina propria immune cells.
Publication date: Available online 23 January 2020Source: Cancer CellAuthor(s): Eric C. Cheung, Gina M. DeNicola, Colin Nixon, Karen Blyth, Christiaan F. Labuschagne, David A. Tuveson, Karen H. VousdenSummaryThe TIGAR protein has antioxidant activity that supports intestinal tissue repair and adenoma development. Using a pancreatic ductal adenocarcinoma (PDAC) model, we show that reactive oxygen species (ROS) regulation by TIGAR supports premalignant tumor initiation while restricting metastasis. Increased ROS in PDAC cells drives a phenotypic switch that increases migration, invasion, and metastatic capacity. This switch ...
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