1,212 results on '"Ulcer surgery"'
Search Results
2. Efficacy of surgical treatments for the management of solitary rectal ulcer syndrome: a network meta-analysis.
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Gaj F, Lai Q, Gelormini E, Ceci M, Di Saverio S, and Quaresima S
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- Humans, Syndrome, Treatment Outcome, Female, Male, Middle Aged, Adult, Rectum surgery, Ulcer surgery, Rectal Diseases surgery, Network Meta-Analysis
- Abstract
Aim: Solitary rectal ulcer syndrome (SRUS) is a benign and poorly understood disorder with complex management. Typical symptoms include straining during defaecation, rectal bleeding, tenesmus, mucoid secretion, anal pain and a sense of incomplete evacuation. Diagnosis is based on characteristic clinical symptoms and endoscopic/histological findings. Several treatments have been reported in the literature with variable ulcer healing rates. This study aimed to evaluate the efficacy of different treatments for SRUS., Materials and Methods: A systematic review and network meta-analysis were performed according to the PRISMA guidelines. Studies in English, French and Spanish languages were included. Papers written in other languages were excluded. Other exclusion criteria were reviews, case reports or clinical series enrolling less than five patients, study duplications, no clinical data of interest and no article available. A systematic literature search was conducted from January 2000 to March 2024 using the following databases: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus. The biases of the studies were assessed using the Newcastle-Ottawa scale or the Jadad scale when appropriate. Types of treatment and their efficacy for the cure of SRUS were collected and critically assessed. The study's primary outcome was to estimate the rate of patients with ulcer healing., Results: A total of 22 studies with 911 patients (men 361, women 550) diagnosed with SRUS were analysed in the final meta-analysis. The pooled effect estimates of treatment efficacy revealed that surgery showed the highest ulcer healing rate (70.5%; 95% CI 0.57-0.83). Surgery was superior in the cure of ulcers with respect to medical therapies and biofeedback (OR 0.09 and OR 0.14)., Conclusion: Solitary rectal ulcer syndrome is a challenging clinical entity to manage. Proficient results have been reported with the surgical approach, suggesting its positive role in cases refractory to medical and biofeedback therapy. Further studies in homogeneous populations are required to evaluate the efficacy of surgery in this setting. (PROSPERO registration number CRD42022331422)., (© 2024 Association of Coloproctology of Great Britain and Ireland.)
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- 2024
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3. Midterm survival after aortic repair versus conservative treatment in patients with penetrating aortic ulcer.
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Wolk S, Prange LS, Kapalla M, Schaab F, Weiss N, Hoffmann RT, and Reeps C
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- Humans, Male, Female, Retrospective Studies, Aged, Risk Factors, Treatment Outcome, Time Factors, Middle Aged, Aged, 80 and over, Risk Assessment, Blood Vessel Prosthesis Implantation mortality, Blood Vessel Prosthesis Implantation adverse effects, Aortography, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Penetrating Atherosclerotic Ulcer, Ulcer mortality, Ulcer diagnostic imaging, Ulcer therapy, Ulcer surgery, Conservative Treatment adverse effects, Conservative Treatment mortality, Computed Tomography Angiography, Aortic Diseases mortality, Aortic Diseases diagnostic imaging, Aortic Diseases therapy, Aortic Diseases surgery
- Abstract
Background: The clinical outcomes and survival of patients with penetrating aortic ulcers (PAU) were evaluated in a tertiary care hospital, comparing those who underwent aortic repair to those treated conservatively. Patients and methods: A retrospective single-centre analysis included all patients that underwent a computed tomography angiography (CT-A) scan with the diagnosis of a PAU between January 2009 and May 2019. "PAU" was identified in 1,493 of 112,506 CT-A scan reports in 576 patients. Clinical and angiomorphological data were collected. The primary outcome was overall survival (OS), with secondary outcomes focusing on identifying risk factors for poor OS. Survival probabilities were analysed by the Kaplan-Meier method using the log-rank test. A Cox hazard model using survival as dependent variable with stepwise backward eliminations based on the likelihood ratios was employed. Results: 315 PAUs were identified in 278 patients. The prevalence in the cohort was 0.8%. The mean age of the patients was 74.4 years, and they were predominantly male (n = 208, 74.8%). The mean ulcer depth was 11.8 mm (range 2-50 mm). Out of the patients, 232 were asymptomatic (83.5%). Among 178 PAUs (56.5%), high-risk factors, such as ulcer depth >10 mm, aortic diameter >40 mm, and ulcer length >20 mm, were observed. Aortic repair was associated with a better mean OS compared to conservatively managed patients (72.6 versus 32.2 months, p = 0.001). The Cox hazard model showed that ulcer depth >1 mm was associated with poor OS (HR 0.67, p = 0.048), while aortic repair was related to a better OS (HR 4.365, p<0.013). Conclusions: Aortic repair is associated with better OS, but this finding should be interpreted with caution because of differences in age and comorbidities between the groups. Further evaluation is warranted through prospective studies with randomized groups. Further assessment for angiomorphological parameters is recommended to identify patients at increased risk for poor OS.
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- 2024
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4. Endoscopic submucosal dissection for superficial esophageal cancer with ulcer scarring using a combination of pocket creation, gel immersion, and red dichromatic imaging.
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Ishikawa T, Tashima T, Muramatsu T, Mashimo Y, and Ryozawa S
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- Humans, Cicatrix diagnostic imaging, Cicatrix etiology, Cicatrix surgery, Immersion, Ulcer diagnostic imaging, Ulcer etiology, Ulcer surgery, Treatment Outcome, Endoscopic Mucosal Resection methods, Esophageal Neoplasms complications, Esophageal Neoplasms surgery
- Abstract
Competing Interests: The authors declare that they have no conflict of interest.
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- 2024
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5. Endovascular Repair of Penetrating Thoracic Aortic Ulcers Using Tubular Stent Grafts Versus Stent Grafts With a Proximal Scallop.
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Kupferthaler A, Hauck SR, Schwarz M, Kern M, Deinsberger J, Dachs TM, Neumayer C, Stelzmüller ME, Ehrlich M, Loewe C, and Funovics MA
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- Humans, Retrospective Studies, Male, Treatment Outcome, Aged, Female, Time Factors, Middle Aged, Risk Factors, Aged, 80 and over, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Endovascular Procedures mortality, Ulcer surgery, Ulcer diagnostic imaging, Ulcer mortality, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Blood Vessel Prosthesis Implantation mortality, Stents, Aortic Diseases diagnostic imaging, Aortic Diseases surgery, Aortic Diseases mortality, Aortic Diseases physiopathology, Aorta, Thoracic surgery, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic physiopathology, Prosthesis Design, Postoperative Complications etiology
- Abstract
Purpose: In penetrating aortic ulcers (PAUs), limited data support tubular thoracic endovascular aortic repair (TEVAR) as a viable treatment option. For treatment of more proximal PAUs, hybrid approaches and-more recently-scalloped TEVAR (scTEVAR) have been advocated. Outcomes of scTEVAR specifically for PAUs have not yet been reported. This study reports long-term outcomes for tubular and scTEVAR in PAUs and compares the safety profile in both cohorts regarding the significantly more proximal landing zone (LZ) for scTEVAR., Materials and Methods: This single-center retrospective cohort study includes all nonacute patients treated for complicated PAU with scTEVAR and tubular TEVAR. Patient and PAU characteristics as well as procedural success, complication and reintervention rates, and all-cause and aortic mortality were analyzed., Results: Of 212 TEVAR procedures reviewed, 21 patients with tubular TEVAR and 19 patients with scTEVAR were included. Patient and PAU characteristics were similar, and LZ was significantly more proximal in the scTEVAR cohort (p=0.0001), with similar number and types of supra-aortic revascularization procedures. Clinical success was reached in all 40 patients (100%), and reintervention rate was 2/21 (9.5%) and 1/19 (5.3%), respectively. Over the mean follow-up of 63 (TEVAR) and 53 (scTEVAR) months, clinical success was stable in all patients with one (abdominal) aortic-related mortality in the scTEVAR cohort., Conclusion: Treatment of complicated PAUs with TEVAR as well as scTEVAR provides excellent and similar clinical success, stability of clinical success, and aortic survival with acceptable complication and reintervention rates. Scalloped TEVAR safely lengthens the proximal sealing zone to address more proximal pathologies., Clinical Impact: Treatment of asymptomatic complicated penetrating aortic ulcers (PAUs) with thoracic endovascular aortic repair (TEVAR) provides excellent clinical success and acceptable complication and reintervention rates. More patients become amenable to endovascular treatment by including scalloped TEVAR (scTEVAR) as a means to safely lengthen the proximal sealing zone to address more proximal pathologies., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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6. Acute Type B Intramural Hematoma: Novel Insights in the Endovascular Era.
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Crepy D'Orleans C, Duwayri YM, Zellner AB, Binongo J, Farrington WJ, Keeling WB, Jordan WD Jr, and Leshnower BG
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- Humans, Retrospective Studies, Aorta, Thoracic surgery, Ulcer surgery, Treatment Outcome, Risk Factors, Hematoma diagnostic imaging, Hematoma etiology, Hematoma surgery, Blood Vessel Prosthesis Implantation adverse effects, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic complications, Endovascular Procedures
- Abstract
Background: The pathophysiology and behavior of acute type B intramural hematoma (TBIMH) is poorly understood. The purpose of this study is to characterize the pathophysiology, fate, and outcomes of TBIMH in the endovascular era., Methods: A retrospective analysis of a US Aortic Database identified 70 patients with TBIMH from 2008 to 2022. Patients were divided into groups and analyzed based upon subsequent management: early thoracic endovascular aortic repair (TEVAR; Group 1) or hospital discharge on optimal medical therapy (OMT) (Group 2)., Results: Of 70 total patients, 43% (30/70) underwent TEVAR (Group 1) and 57% (40/70) were discharged on OMT (Group 2). There were no significant differences in age, demographics, or comorbidities between groups. Indications for TEVAR in Group 1 were as follows: 1) Penetrating atheroscletoic ulcer (PAU) or ulcer-like projection (n = 26); 2) Descending thoracic aortic aneurysm (n = 3); or 3) Progression to type B aortic dissection (TBAD) (n = 2). Operative mortality was zero. No patient suffered a stroke or spinal cord ischemia. During the follow-up period, 50% (20/40) of Group 2 patients required delayed surgical intervention, including TEVAR in 14 patients and open repair in 6 patients. Indications for surgical intervention were as follows: 1) Development of a PAU / ulcer-like projection (n = 13); 2) Progression to TBAD (n = 3), or 3) Concomitant aneurysmal disease (n = 4). Twenty patients did not require surgical intervention. Of the initial cohort, 71% of patients required surgery, 9% progressed to TBAD, and 19% had regression or stability of TBIMH with OMT alone., Conclusions: The most common etiology of TBIMH is an intimal defect. Progression to TBAD and intramural hematoma regression without an intimal defect occurs in a small percentage of patients. An aggressive strategy with endovascular therapy and close surveillance for TBIMH results in excellent short-term and long-term outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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7. Surgical treatment and outcomes of acute and chronic ulcers on the penis following injection of foreign substances.
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Dunev VR
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- Male, Humans, Ulcer etiology, Ulcer surgery, Penis surgery, Skin Transplantation methods, Treatment Outcome, Penile Diseases etiology, Penile Diseases surgery, Plastic Surgery Procedures, Skin Diseases surgery
- Abstract
In this paper, we present our experience with acute and chronic penile ulcers resulting from injection of an exogenous substance and their surgical treatment., (© 2024 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)
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- 2024
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8. Descending thoracic aortic mural ulceration is associated with postoperative spinal cord ischemia after branched endovascular aortic aneurysm repair.
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Huynh C, Liu I, Sommer A, Menke L, Reilly L, Gasper W, and Hiramoto J
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- Humans, Endovascular Aneurysm Repair, Ulcer surgery, Risk Factors, Paraplegia diagnosis, Paraplegia etiology, Paraparesis etiology, Treatment Outcome, Retrospective Studies, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracoabdominal, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures, Spinal Cord Ischemia diagnosis, Spinal Cord Ischemia etiology, Spinal Cord Ischemia prevention & control, Thrombosis etiology
- Abstract
Objective: Paraplegia is one of the most feared complications after thoracoabdominal aortic aneurysm repair. The purpose of this study is to determine whether aortic thrombus characteristics are associated with spinal cord ischemia (SCI) after branched endovascular aneurysm repair (BEVAR)., Methods: From April 2011 to April 2020, 62 patients underwent elective BEVAR for thoracoabdominal aortic aneurysm and pararenal aortic aneurysms using a low-profile device and had a complete preoperative computed tomography angiography of the aorta from the sinotubular junction to the aortic bifurcation. Aortic thrombus was evaluated for thrombus thickness ≥5 mm, thrombus >2/3 of aortic circumference, and the presence of an ulcer-like thrombus. One point was assigned at each 5 mm axial image if all 3 criteria were met, resulting in a total "shaggy score" for the entire aorta. Data on demographics, procedural details, and outcomes were collected prospectively. All patients underwent a standard spinal cord protection protocol, including routine cerebrospinal fluid drainage. In July 2016, an insulin infusion protocol (IIP) was initiated to maintain postoperative blood glucose levels <120 mg/dL for 48 hours. The primary clinical end point was postoperative SCI., Results: 10 (16%) patients developed postoperative SCI: 6 with transient paraparesis, 2 with persistent paraparesis, and 2 with persistent paraplegia. Patients with SCI were older, had higher shaggy scores, and were less likely to have been on an IIP. There were no significant differences in demographics, aneurysm type, or operative parameters. In a logistic multivariate regression model for SCI, age (odds ratio [OR]: 1.2 [1.1-1.4], P = .02) and shaggy score (OR: 1.2 [1.1-1.4], P = .02) were independently associated with increased risk of SCI, whereas treatment with the IIP was associated with lower risk of SCI (OR: 0.04 [0.006-0.50], P = .05). Of the individual components of the shaggy score, higher descending thoracic aortic ulcer scores were the most strongly associated with postoperative SCI (P = .009)., Conclusions: Preoperative characterization of aortic wall thrombus is an important adjunctive tool for individualized clinical decision-making and patient counseling about the risk of SCI after BEVAR., Competing Interests: Disclosures J.H. has received royalties from licensed patents to Cook Medical (spouse). All other authors declare nothing to disclose relevant to this work., (Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2024
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9. [Clinical diagnosis and treatment of 14 cases of scar cancer ulcer wound on head and face].
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Chen X and Huang G
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- Middle Aged, Aged, Female, Humans, Male, Young Adult, Adult, Aged, 80 and over, Cicatrix therapy, Cicatrix surgery, Ulcer surgery, Retrospective Studies, Skin Transplantation, Treatment Outcome, Plastic Surgery Procedures, Carcinoma, Squamous Cell surgery, Burns complications, Burns therapy, Soft Tissue Injuries surgery, Free Tissue Flaps, Skin Neoplasms surgery, Perforator Flap transplantation
- Abstract
Objective: To analyze the clinical characteristics of scar cancer ulcer wound of head and face, and to investigate its diagnosis and treatment., Methods: The clinical data of 14 patients with head and facial scar cancer ulcer wounds who met the selection criteria and admitted between January 2021 and March 2022 were retrospectively analyzed. There were 8 males and 6 females. The age of onset ranged from 21 to 81 years with an average age of 61.6 years. The incubation period ranged from 1 month to 70 years, with a median of 4 years. Site of the disease included 7 cases of head, 6 cases of maxillofacial region, and 1 case of neck region. Injury factors included trauma in 5 cases, scratch in 5 cases, scalding in 2 cases, burn in 1 case, and needle puncture in 1 case. Pathological results showed squamous cell carcinoma in 9 cases, basal cell carcinoma in 3 cases, sebaceous adenocarcinoma in 1 case, papillary sweat duct cystadenoma combined with tubular apocrine sweat gland adenoma in 1 case. There was 1 case of simple extensive tumor resection, 1 case of extensive tumor resection and skin grafting repair, 7 cases of extensive tumor resection and local flap repair, and 5 cases of extensive tumor resection and free flap repair., Results: All the 14 patients were followed up 16-33 months (mean, 27.8 months). Two patients (14.29%) had scar cancer ulcer wound recurrence, of which 1 patient recurred at 2 years after 2 courses of postoperative chemotherapy, and was still alive after oral traditional Chinese medicine treatment. One patient relapsed at 1 year after operation and died after 2 courses of chemotherapy. One patient underwent extensive resection of the left eye and periocular tumor and the transfer and repair of the chimaeric muscle axial flap with the perforating branch of the descending branch of the left lateral circumflex femoral artery, but the incision healing was poor after operation, and healed well after anti-infection and debridement suture. The wounds of other patients with scar cancer ulcer did not recur, and the wounds healed well., Conclusion: Scar cancer ulcer wound of the head and face is common in the middle-aged and elderly male, and the main pathological type is squamous cell carcinoma. Local extensive resection, skin grafting, or flap transfer repair are the main treatment methods. Early active treatment of wounds after various injuries to avoid scar repeated rupture and infection is the foundamental prevention of scar cancer.
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- 2024
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10. Perforated Ischemic Ulcer at the Jejuno-Jejunal Anastomosis 9 Years Post-laparoscopic Roux-en-Y Gastric Bypass-a Case Report.
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Elhardello OA, Athamnah MN, and ElSeify GH
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- Female, Humans, Middle Aged, Ulcer etiology, Ulcer surgery, Ischemia etiology, Ischemia surgery, Anastomosis, Roux-en-Y adverse effects, Gastric Bypass adverse effects, Gastric Bypass methods, Obesity, Morbid surgery, Vascular Diseases etiology, Laparoscopy adverse effects, Laparoscopy methods
- Abstract
Background: Obesity is a common disease among Kuwaitis. Multiple types of bariatric procedures are offered in Kuwait. R-Y gastric bypass is among the common surgeries performed. Early and late complications must be recognized as early as possible to avoid undesirable consequences., Case Presentation: Here, we present a case of a 48-year-old lady presented as acute abdominal pain and diagnosed as Jejuno-Jejunal anastomosis site ulceration / perforation taking place several years from surgery., Discussion: Etiology of late perforation can be attributed to ischemia. Computerized tomography (C.T.) scan is the gold standard for diagnosis. Management can be laparoscopic or open surgery depending on surgeon expertise. We performed a laparoscopic resection for the extended perforated jejunal recess and that was enough to resolve our patient's problem., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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11. Plaque Ulcerations are Associated with Recurrence in Symptomatic Low-Grade Carotid Stenosis.
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Shimonaga K, Ikedo T, Yamada N, Niwa A, Kushi Y, Hamano E, Yamada K, Imamura H, Mori H, Hatakeyama K, Iihara K, and Kataoka H
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- Humans, Aged, Retrospective Studies, Ulcer complications, Ulcer diagnostic imaging, Ulcer surgery, Risk Factors, Recurrence, Carotid Stenosis complications, Carotid Stenosis diagnostic imaging, Carotid Stenosis surgery, Plaque, Atherosclerotic pathology, Brain Ischemia etiology, Stroke etiology
- Abstract
Objective: Surgical indications for low-grade carotid stenosis have not yet been established. This study aimed to clarify the characteristics of low-grade carotid stenosis refractory to medical treatment., Methods: We retrospectively analyzed 48 patients with symptomatic low-grade carotid stenosis (<50%). Recurrence was defined as an ipsilateral ischemic event in the symptomatic lesions during the follow-up period. Patient demographics and imaging findings were compared between the recurrence and nonrecurrence groups to investigate risk factors associated with medical treatment., Results: The mean age was 74.1 (58-90 years), and the mean follow-up period was 35.4 months (2.0-97 months). Recurrence occurred in 15 of the symptomatic patients. Ulceration was significantly associated with recurrence under medical treatment (P = 0.001). The median time to recurrence was 26.1 months in patients with ulcers and 54.3 months in those without ulcers (P = 0.04). Pathological study with recurrence showed plaque rupture with multilayered lesions, indicating lesions refractory to medical treatment., Conclusions: In cases of low-grade carotid stenosis, lesions with ulcerations are likely refractory to medical therapy. Consideration of the indications for surgical treatment may be warranted for lesions with ulceration, even if the degree of stenosis is low., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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12. Predicting Factors of Long-term Outcome of Gastrointestinal Behçet's Disease: A Chinese Retrospective Study.
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Zu X, Xiong S, Lu Y, Zhang N, Xu S, Feng R, Chen B, Zeng Z, Chen M, and He Y
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- Humans, Adult, Ulcer etiology, Ulcer surgery, Ulcer diagnosis, Retrospective Studies, China epidemiology, Behcet Syndrome diagnosis, Behcet Syndrome drug therapy, Behcet Syndrome surgery, Gastrointestinal Diseases etiology
- Abstract
Purpose: Behçet's disease (BD) is a complex disorder affecting multiple systems and organs, and gastrointestinal BD is poorly understood. We aimed to identify factors influencing the long-term outcomes of patients with gastrointestinal BD., Methods: Consecutive patients with gastrointestinal BD were analyzed retrospectively. Data on the following clinical characteristics were collected: sex, age at diagnosis, symptoms, endoscopic findings, medical treatments, and surgery. Mucosal healing and surgical rates at 1, 2, and 5 years were evaluated. Log-rank test and Cox proportional hazards regression models were used to evaluate the factors affecting long-term outcomes., Findings: Baseline data of 175 patients with gastrointestinal BD were included. The mean (SD) age at diagnosis was 38.3 (12.9) years. The typical clinical symptoms were oral ulcer (72.6%), abdominal pain (71.4%), and weight loss (41.1%). The most commonly involved location was the ileocecum; isolated oval ulcer was the most common ulcer type. Seventeen patients (9.7%) underwent 18 surgeries after inclusion. The cumulative surgical rates were 8.6% (n/N = 15/175), 8.6% (n/N = 15/175), and 9.1% (n/N = 16/175) in 1, 2, and 5 years, respectively. Data from 101 patients who underwent at least 2 endoscopies were included in the analysis for mucosal healing. Kaplan-Meier curve showed that the cumulative mucosal healing rates at 1, 2, and 5 years were 34.7% (n/N = 35/101), 41.6% (n/N = 42/101), and 61.4% (n/N = 62/101), respectively. We compared cumulative mucosal healing rates between 4 treatment groups, including 5-aminosalicylic acid (3% [n/N = 3/101]), mono-immunosuppressant (31.7% [n/N = 32/101]), combined therapy (36.6% [n/N = 37/101]), and escalation therapy (28.7% [n/N = 29/101]), and found that mono-immunosuppressant achieved earlier mucosal healing than combined therapy (P = 0.0008) and escalation therapy (P = 0.0008). The univariate analysis showed that moderate to severe disease activity (P = 0.013, P = 0.004), diameter of the maximal ulcer >4 cm (P = 0.002), and nonsimple esophageal involvement (P < 0.001) were risk factors, and number of ulcers between 2 and 5 was the protective factor of mucosal healing (P = 0.001). Multivariate regression analysis indicated that nonsimple esophageal involvement (P < 0.001) and the maximal ulcer >4 cm (P = 0.041) were independent risk factors of mucosal healing., Implications: Most patients with gastrointestinal BD need long-term treatment to achieve mucosal healing. The location and size of ulcers have a significant impact on the mucosal healing of gastrointestinal BD., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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13. Corneal stromal lenticule transplantation for the treatment of corneal ulcers.
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Min Klimesova Y, Nemcokova M, Netukova M, Baxant AD, Hlavackova M, Kacerovska J, and Studeny P
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- Male, Humans, Female, Adult, Middle Aged, Aged, Aged, 80 and over, Retrospective Studies, Ulcer surgery, Corneal Stroma surgery, Corneal Ulcer surgery, Corneal Transplantation methods
- Abstract
Purpose: To evaluate the safety and efficacy of using corneal stromal lenticules (CSLs) obtained during refractive surgery Refractive Lenticule Extraction (ReLEx) with the Small Incision Lenticule Extraction (SMILE) procedure for the treatment of corneal ulcers., Methods: This retrospective study included 12 eyes of 12 patients, 7 men and 5 women with varying degrees of corneal ulcer. The mean age was 64 ± 18 (range 34 to 95 years). The monitoring included corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, a Seidel test, stability of the graft and anterior segment optical coherence tomography (AS-OCT) inspection. Patients were closely monitored for possible postoperative complications for at least 6 months., Results: In 7/12 (58%) eyes, the corneal ulcer was successfully sealed with CSL and amniotic membrane (AM) without the need for any additional surgical intervention. In 3 eyes, penetrating keratoplasty (PK) was needed in addition to CSL transplantation and in 2 eyes the scleral patch was used to fully seal after CSL transplantation. During the follow-up period no signs of rejection or infection were detected in any patient., Conclusion: The use of CSLs from ReLEx SMILE may be considered as an alternative method for the treatment of corneal ulcers before a more extensive and definitive solution - PK - is used. Our preliminary findings suggest that properly performed CSL transplantation using cryopreserved lenticules is a safe and effective method to temporarily cover the corneal partial-thickness defect or even perforation., Competing Interests: The authors report no conflicts of interest in this work.
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- 2024
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14. Unusual case of retroperitoneal hematoma and duodenal ulcerative bleeding after nephrectomy: Case report.
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Luo Y, Li Q, Liao Z, and Luo Z
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- Female, Humans, Aged, Ulcer surgery, Ulcer complications, Duodenum pathology, Gastrointestinal Hemorrhage surgery, Gastrointestinal Hemorrhage complications, Hematoma etiology, Hematoma surgery, Hematoma diagnosis, Nephrectomy adverse effects, Carcinoma, Transitional Cell pathology, Urinary Bladder Neoplasms pathology, Duodenal Ulcer complications, Duodenal Ulcer surgery, Peritoneal Diseases surgery
- Abstract
Rationale: Retroperitoneal hematomas are relatively common in patients undergoing nephrectomy. Herein, we report an unusual case involving a giant retroperitoneal hematoma and subsequent duodenal ulcerative bleeding following a radical nephrectomy., Patient Concerns: A 77-year-old woman was admitted to our hospital for lower back pain, and she had severe right hydronephrosis and a urinary tract infection., Diagnoses: The patient was diagnosed and confirmed as high-grade urothelial carcinoma., Interventions: After ineffective conservative treatments, a right radical nephrectomy and ureteral stump resection were performed. The patient received proton pump inhibitors to prevent stress ulcer formation and bleeding. On the first day post-surgery, she had normal gastrointestinal (GI) endoscopy findings. On the second day post-surgery, abdominal computed tomography revealed a retroperitoneal hematoma. Notably, 14 days post-surgery, massive GI bleeding occurred, and GI endoscopy identified an almost perforated ulcer in the bulbar and descending duodenum., Outcomes: The patient died on day 15 after surgery., Lessons: Duodenal ulceration and bleeding might occur following a retroperitoneal hematoma in patients treated with nephrectomy. Timely intervention may prevent duodenal ulcers and complications, and thus could be a promising life-saving intercession., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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15. To Mesh or Not to Mesh: What Is the Ideal Meshing Ratio for Split Thickness Skin Grafting of the Lower Extremity?
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Shin SE, Spoer D, Franzoni G, Berger L, Hill A, Sayyed AA, Noe N, Steinberg JS, Attinger CE, and Evans KK
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- Humans, Lower Extremity surgery, Retrospective Studies, Leg Ulcer surgery, Chronic Disease, Skin Transplantation methods, Ulcer surgery
- Abstract
Split-thickness skin grafts can provide effective autologous wound closure in patients with dysvascular comorbidities. Meshing the graft allows for reduced donor site morbidity and expanded coverage. This study directly compares outcomes across varying meshing ratios used to treat chronic lower extremity wounds. Patients who received split-thickness skin grafts to their lower extremity for chronic ulcers from December 2014 to December 2019 at a single center were retrospectively reviewed. Patients were stratified by meshing ratios: nonmeshed (including pie crusting), 1.5:1, and 3:1. The primary outcome was clinical "healing" as determined by surgeon discretion at 30 days, 60 days, and the latest follow-up. Secondary outcomes included postoperative complications, graft loss, ulcer recurrence, progression to amputation, and mortality. A total of 321 patients were identified. Wound sizes and location differed significantly, with 3:1 meshing applied to the largest wounds (187.8 ± 157.6 cm
2 ; 1.5:1 meshed, 110.4 ± 103.9 cm2 ; nonmeshed 38.7 ± 55.5 cm2 ; p < .0001) mostly of the lower leg (n = 18, 75%; 1.5:1 meshed, n = 23, 43.4%; nonmeshed n = 62, 25.7%; p < .0001). Meshed grafts displayed a significantly higher proportion of healing at 30 and 60 days, but no differences persisted by the final follow-up (16.5 ± 20.5 months). Longitudinally, nonmeshed STSG was associated with most graft loss (46, 19.1%; p = .011) and ulcer recurrence (44, 18.3%; p = .011). Of the 3 meshing ratios, 3:1 exhibited the lowest rates of complications. Our results suggest that 3:1 meshing is a safe option for coverage of large lower extremity wounds to minimize donor site morbidity., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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16. Meta-analysis of stereotactic hematoma removal and craniotomy hematoma removal in the treatment of hypertensive intracerebral hemorrhage in the elderly.
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Tang C, Zhang M, and Li W
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- Aged, Middle Aged, Humans, Ulcer surgery, Treatment Outcome, Craniotomy methods, Cerebral Hemorrhage surgery, Hematoma etiology, Hematoma surgery, Retrospective Studies, Intracranial Hemorrhage, Hypertensive surgery
- Abstract
Background: A large number of clinical studies suggested that surgery might be a better choice than conservative treatment for treating hypertensive intracerebral hemorrhage in the middle-aged and elderly. Stereotactic puncture can reduce the mass effect caused by hematoma, reduce the intervention of body homeostasis, reduce brain tissue damage, and improve the prognosis of patients with cerebral hemorrhage. This meta-analysis aims to evaluate the efficacy of stereotactic puncture and craniotomy in elderly patients with hypertensive intracerebral hemorrhage., Methods: A search strategy was designed to search in databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Wanfang database and relevant references. Literature on the efficacy and safety of different surgical methods for hypertensive cerebral hemorrhage in the middle-aged and elderly were retrieved. The search time was until August 17, 2022. Keywords included "hypertensive intracerebral hemorrhage," "stereotactic hematoma removal," "craniotomy." After the literature search, 2 researchers independently conducted literature screening, quality evaluation of included trials and data extraction. RevMan5.4 software was used to perform a Meta-analysis on the operation time, hospital stay, postoperative Glasgow Coma Scale (GCS) score, postoperative daily activity ability, postoperative complications and neurological prognosis scores included in the included studies., Results: A total of 1988 samples were included in 9 studies. 1022 patients underwent stereotactic hematoma removal, and 968 patients underwent craniotomy hematoma removal. The orientation group had more advantages in the length of hospital stay, postoperative disability, pulmonary infection, intracranial infection and digestive tract ulcer, and the difference was statistically significant (P < .05). In addition, the length of stay (I²= 83%) of the included articles had good homogeneity (I²< 50%), and there was no significant difference between the 2 groups in operation time, postoperative GCS score, postoperative daily activity ability, and neurological prognosis score (P > .05)., Conclusion: The meta-analysis indicate that compared to craniotomy for hematoma removal, stereotactic hematoma removal can reduce the postoperative disability rate, intracranial infection rate, lung infection rate, and digestive tract ulcer rate in middle-aged and elderly patients with hypertensive intracerebral hemorrhage., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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17. Recurrent Anastomotic Ulcer After Roux-en-Y Gastric Bypass: a Video Case Report and Review of Treatment Options.
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Alromayan M, Thomas S, Abdelrahmane A, Chierici A, and Iannelli A
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- Humans, Ulcer surgery, Anastomosis, Roux-en-Y, Gastric Bypass adverse effects, Obesity, Morbid surgery, Gastrointestinal Diseases surgery, Laparoscopy
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- 2023
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18. Simple extraction method using a nontraumatic tube for impacted stool in a diverticulum near the ulcer floor after endoscopic submucosal dissection.
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Koyama Y, Fukuzawa M, Yamanishi F, Matsumoto T, Yamaguchi H, Kawai T, and Itoi T
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- Humans, Ulcer etiology, Ulcer surgery, Gastroscopy, Endoscopic Mucosal Resection, Diverticulum, Stomach Neoplasms
- Abstract
Competing Interests: The authors declare that they have no conflict of interest.
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- 2023
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19. Marginal Ulcer Following Completion Pancreatectomy Complicated by Portal Vein Erosion.
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Torres-Ruiz TA, Wharry L, and Simo KA
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- Female, Humans, Middle Aged, Pancreatectomy adverse effects, Ulcer surgery, Portal Vein surgery, Retrospective Studies, Pancreatic Neoplasms surgery, Carcinoma, Pancreatic Ductal surgery, Pancreatic Intraductal Neoplasms surgery, Peptic Ulcer surgery
- Abstract
Marginal ulcers, defined as ulcers at the duodenojejunostomy or gastrojejunostomy, are a known late-onset complication of pancreaticoduodenectomy (PD) and total pancreatectomy (TP) with mean incidence ranging from 5.4% to 36% per the literature. These ulcers carry a risk of complications including hemorrhage or perforation which can result in significant mortality. Marginal ulcers from PD and TP causing portal vein erosion are extremely rare and given the high incidence of mortality, it is important to have a multimodal approach to the treatment with awareness that early operative management should be considered if other modalities fail. We discuss the case of a 57-year-old female with history of pancreatic tail intraductal papillary mucinous neoplasm (IPMN) status post distal pancreatectomy/splenectomy and subsequent completion pancreatectomy for pancreatic head IPMN who presented with acute gastrointestinal bleed. The patient was successfully managed operatively with primary repair of the marginal ulcer after multiple failed endoscopic attempts., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2023
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20. Whole Foods Introduction Associated With Symptomatic Anastomotic Ulceration in Children With Short Bowel Syndrome.
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Zong W, Salich J, Kastl A, Kirsch J, Albenberg L, and Bales C
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- Humans, Child, Retrospective Studies, Constriction, Pathologic etiology, Follow-Up Studies, Ulcer etiology, Ulcer surgery, Anastomosis, Surgical adverse effects, Treatment Outcome, Short Bowel Syndrome complications, Short Bowel Syndrome surgery, Intestinal Obstruction etiology
- Abstract
Objectives: Anastomotic ulceration (AU) is a rare but life-threatening complication of pediatric short bowel syndrome (SBS). AUs may be challenging to detect and refractory to treatment. This study aimed to identify features associated with symptomatic bleeding AUs in children with SBS and factors that may impact resolution of bleeding. The relationship between dietary changes and symptomatic anastomotic hemorrhage was also explored., Methods: We conducted a retrospective chart review of 381 patients cared for in the Intestinal Rehabilitation Program at our center from 2013 to 2022. Patients with symptomatic AUs were identified based on at least 1 endoscopic procedure showing AUs and evidence of clinically significant gastrointestinal bleeding. We collected patient demographics, clinical characteristics, dietary history, radiologic imaging, and histopathology. We used descriptive statistics to identify patterns of presentation., Results: AUs were identified in 22 patients who were followed for a median duration of 2.9 years after anastomotic ulcer identification. AUs uniformly evolved years after the initial anastomosis (median 3.2 years). Characteristics included bowel stricture (4/22), small bowel-colon anastomosis (19/22), partial colectomy (17/22), and an increase in whole foods fraction (12/18). Bleeding resolved with operative intervention in the majority with anastomotic stricture (3/4). Recurrent bleeding was common in those without stricture (13/18). In a subset of patients without stricture, whole food reduction was associated with improvement or resolution of bleeding (5/6)., Conclusions: We observed a higher proportion of patients with AUs who responded to surgical intervention in the subset of children with definitive anastomotic strictures versus those without, suggesting that careful characterization of intestinal anatomy may be critical to predicting response to therapy. We also observed that bleeding from AU typically first manifested within 1 year of a shift from elemental or hydrolyzed enteral formula to a whole food-based diet (including commercial blenderized feeds), which may indicate that components of the enteral diet play a role in the pathogenesis of AU. Further studies are needed to validate these hypotheses., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)
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- 2023
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21. Abdominal Penetrating Aortic Ulcer and Endovascular Treatments: A Systematic Review and Meta-Analysis.
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Wang B, Qiu C, Yu X, He Y, Chen T, Lin R, Wang X, Pan J, Wang X, Zhang H, and Wu Z
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- Male, Humans, Aged, Treatment Outcome, Aorta surgery, Ulcer diagnostic imaging, Ulcer surgery, Risk Factors, Blood Vessel Prosthesis, Penetrating Atherosclerotic Ulcer, Endovascular Procedures, Hypertension, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects
- Abstract
Background: Abdominal penetrating aortic ulcer (aPAU) is defined as an ulceration of the aortic intima and media lamina, even with rupture of the internal elastic lamina. Recently, there have been an increasing number of publications on endovascular treatment for aPAU. This review aimed to assess the efficacy and safety of endovascular treatment and provide clinicians with the latest evidence-based medical data., Methods: 3 academic databases (Embase, PubMed, and Scopus) were systematically searched for literature reporting on aPAU from 1986 (the earliest appearance of the concept of aPAU) to September 1, 2021, and related data were collected and evaluated. A fixed/random effects model was used to construct the forest plots. Funnel plots and linear regression tests were used to assess the publication bias., Results: 6 articles including 121 patients were included in the analysis. The average age was 71.4 years, with 72.7% of males and 85.6% with hypertension. Saccular aneurysms (SA) were the most prevalent complication (35.5%). Endovascular treatment had a perioperative mortality rate of .24% (95% CI, .00-2.70). The technical success rate was 99.15% (95% CI, 96.49-100). The type-II endoleak rate was 5.69% (95% CI, .00-12.13). The 1-year survival rate was 95.69% (95% CI, 90.49-100). The revascularization rate was 7.20% (95% CI, .07-14.32). Endovascular treatments for aPAU would lead to a high rate of technical success, few complications, and satisfactory 1-year survival., Conclusions: aPAU are a common disease that mainly affects elderly males with hypertension and hyperlipidemia. Endovascular treatment is required when an ulcer progresses rapidly or manifests symptoms. Endovascular treatment is associated with high technical success, low complication, and satisfactory 1-year survival. Further investigation into the long-term results of endovascular treatment is necessary.
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- 2023
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22. Outcomes of symptomatic penetrating aortic ulcer and intramural hematoma in the endovascular era.
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Bellomo TR, DeCarlo C, Khoury MK, Lella SK, Png CYM, Kim Y, Pendleton AA, Majumdar M, Zacharias N, and Dua A
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- Humans, Aorta, Hematoma diagnostic imaging, Hematoma etiology, Hematoma surgery, Ulcer diagnostic imaging, Ulcer surgery, Treatment Outcome, Retrospective Studies, Penetrating Atherosclerotic Ulcer, Aortic Diseases diagnostic imaging, Aortic Diseases surgery
- Abstract
Background: Although endovascular technology has resulted in a paradigm shift in treatment, medical management remains the standard of care for penetrating aortic ulcer (PAU) and intramural hematoma (IMH). This study aimed to detail the short- and long-term outcomes of symptomatic PAU/IMH., Methods: Institutional data on symptomatic PAU/IMH were gathered (2005-2020). The primary outcome was the composite of recurrent symptoms, radiographic progression, intervention, rupture, and death from related or unknown cause. Factors associated with the primary outcome were determined using a Fine-Gray model with death from an unrelated cause as a competing risk., Results: A total of 83 symptomatic patients treated with medical management aside from ruptures and type A dissections: 21 isolated PAU, 30 isolated IMH, and 32 IMH and PAU. Adverse outcomes included symptom recurrence in 14 (16.9%), radiographic progression to dissection or saccular aneurysm in 17 (20.5%), surgery in 20 (24.1%) (17 thoracic endovascular aortic repair, 1 endovascular aortic repair, 1 frozen elephant trunk, and 1 open repair), and rupture in 4 (4.8%). Twenty-seven patients (32.5%) died during follow-up: 6 from IMH treatment complications, 8 from an unknown cause, and 13 from other causes. The 30-day, 1-year, and 5-year cumulative incidences of the primary outcome was 26.5% (95% confidence interval [CI], 16.9%-37.0%), 44.9% (95% CI, 32.8%-56.2%), and 57.5% (95% CI, 42.4%-69.9%), respectively. IMH with PAU was associated with a significantly higher risk of the primary outcome compared with isolated IMH (subdistribution hazard ratio, 2.21; 95% CI, 1.09-4.50; P = .027) and isolated PAU (subdistribution hazard ratio, 3.58; 95% CI, 1.44-8.88; P = .006)., Conclusions: Complications from symptomatic PAU and IMH are frequent, with intervention, recurrent symptoms, radiographic progression, rupture, or death affecting 25% of patients at 30 days after diagnosis and almost one-half of patients 1 year after diagnosis. Given the high rate of adverse events in this population, investigation into a more aggressive interventional strategy may warranted, especially in patients with a combined IMH and PAU., (Copyright © 2023. Published by Elsevier Inc.)
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- 2023
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23. Indications and outcomes of keratoplasty ≤ 5.5 mm diameter ("mini-keratoplasty").
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Fathai H, Geerling G, and Menzel-Severing J
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- Humans, Male, Female, Young Adult, Adult, Middle Aged, Aged, Aged, 80 and over, Infant, Keratoplasty, Penetrating, Ulcer surgery, Postoperative Complications surgery, Graft Survival, Retrospective Studies, Treatment Outcome, Diabetes Mellitus, Type 2, Corneal Transplantation, Corneal Diseases surgery, Corneal Ulcer surgery, Corneal Dystrophies, Hereditary surgery
- Abstract
Purpose: To report indications and clinical outcomes of corneal grafts ≤ 5.5 mm in diameter ("mini-KP") in a German tertiary referral center., Methods: Patients who had undergone mini-KP to treat corneal ulcers with or without perforation between 2011 and 2018 at the Department of Ophthalmology, University of Düsseldorf, Germany, were identified from the local keratoplasty registry. All patient records were reviewed for age, gender, laterality, systemic and ophthalmological diseases, etiology of the corneal ulcerative disease, pre- and postoperative visual acuity over a follow-up time of up to 12 months, graft size, postoperative complications and the need for and timing of further corneal interventions., Results: 37 eyes of 37 patients (male: n = 20; female: n = 17) with a mean age (± standard deviation) at presentation of 70 ± 18.8 years (range: 22-92 years) were identified. Most common etiologies were neurotrophic keratopathy (n = 15), dysfunctional tear syndrome (n = 9) and atopic keratoconjunctivitis (9). Mean graft diameter was 4.51 ± 0.63 mm (range: 3-5.5 mm). 23/37 eyes (62%) required no further intervention in the acute phase. 14/37 patients (38%) required secondary corneal intervention, due to complications. One-year graft survival was 78.4%. One eye had to be eviscerated due to recurrent corneal ulceration and endophthalmitis. 36 of 37 eyes were preserved. We found a highly significant correlation between type 2 diabetes and the development of postoperative complications (r = .46; p = .005). Corrected distance visual acuity (CDVA) improved from 1.42 ± 0.75 logMAR to 0.9 ± 0.65 logMAR postoperatively (t (23) = 5.76; p < .001)., Conclusion: Mini-KP can be used successfully in eyes with advanced corneal ulcers due to various infectious and noninfectious etiologies to restore tectonic stability in the long-term and with moderate visual gains., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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24. Behçet's disease with intestinal involvement: a case report and review of the literature.
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Li L, Wang J, Li H, He C, and Niu X
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- Female, Humans, Middle Aged, Ulcer etiology, Ulcer surgery, Adalimumab, Inflammation complications, Behcet Syndrome complications, Behcet Syndrome diagnosis, Intestinal Diseases diagnosis, Intestinal Diseases etiology, Intestinal Diseases surgery, Vasculitis
- Abstract
Background: Behçet's disease (BD) is a chronic systemic disease characterized by vasculitis as the basic pathological change. BD is rare, and gastrointestinal involvement occurs in 3% to 25% of affected patients. This article describes a rare case of intestinal BD along with a literature review of intestinal involvement in BD., Case Presentation: A 50-year-old Han woman from China presented with a > 6-month history of distending pain in the right upper abdomen. Because of mechanical obstruction secondary to stricture formation from an ileocecal ulcer, she underwent radical right colon resection, and postoperative pathologic examination indicated an ileocecal ulcer. The patient was readmitted to the hospital 6 months postoperatively for recurrence of the same symptoms. Colonoscopy indicated obvious narrowing of the anastomosis with an oval-shaped deep ulcer that could not be passed by the endoscope. Pathologic examination showed acute and chronic inflammation of the anastomotic mucosa and granulation tissue. In addition, gastroscopy showed a 3.0- × 4.0-cm giant ulcer at the junction of the descending bulb along with a sinus tract. Moreover, total gastrointestinal computed tomography angiography showed significant thickening of the intestinal wall near the transverse colon, forming a sinus tract at the junction of the antrum and duodenum with a length of about 1.3 cm and width of about 0.2 cm. Further inquiry regarding the patient's medical history revealed that she had developed repeated oral ulcers 3 years previously and repeated eye inflammation 5 years previously. Specimens of the right half of the colon removed 6 months previously were sent to Run Run Shaw Hospital Affiliated to Zhejiang University for consultation. The pathologic examination revealed vasculitis in the submucosa and subserosa, and the patient was finally diagnosed with BD. She began treatment with adalimumab, and repeat gastroenteroscopy revealed that the intestinal ulcer had significantly improved., Conclusions: An oval-shaped deep intestinal ulcer is a characteristic lesion in patients with BD and may involve the intestinal muscle layer. This case emphasizes that BD is a vasculitis affecting multiple organs and can present with a single, deep, clean-edged intestinal ulcer that penetrates the bowel wall to form a sinus tract. Therefore, careful examination and differential diagnosis should be carried out to prevent a poor prognosis. Adalimumab is effective for patients with intestinal BD., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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25. Минуле, сучасне та майбутнє хірургічного лікування виразкової хвороби (50-річний досвід інституту)
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N.V. Prolom, V.M. Ratchick, A.M. Babii, S.A. Таrabarov, and B.F. Shevchenko
- Subjects
medicine.medical_specialty ,business.industry ,Ulcer surgery ,medicine.medical_treatment ,General surgery ,Peptic ulcer surgery ,Disease ,Gastroenterostomy ,medicine.disease ,digestive system diseases ,Conservative treatment ,Peptic ulcer ,Medicine ,business ,Surgical treatment ,Gastric resection - Abstract
The article presents the literature data and the results of the author’s own research on the development of peptic ulcer surgery in the historical aspect. It is shown that the evolution of the knowledge about the etiopathogenesis of peptic ulcer influenced the development of methods for surgical interventions. The main periods of development of peptic ulcer surgery are identified: the first period (1842–1881) — the time of the formation of gastric surgery; the second period (1880–90s) — the time of gastric surgery becoming an independent clinical discipline; the third period (the end of the 19th century — 1920s) — the time of peptic ulcer surgery development, when gastroenterostomy was the method of choice in surgical treatment; the fourth period (1930–60s) — the time when the pathogenetic principles of peptic ulcer surgery appeared; gastric resection served as a method of choice; the fifth (the final) period (1970–90s — present time) — the summing up of the 150-year history of ulcer surgery, when doctors tend to conservative treatment of this complex pathology, and surgical intervention in peptic ulcer is directed only to сorrection of disease complications, without destroying the digestive system. It is shown that the historical experience, the thorny path of hopes and disappointments that doctors have taken when searching an optimal approaches to the surgical treatment of peptic ulcer, will help surgeons, therapists, morphologists and physiologists in the future.
- Published
- 2021
26. Changes in Acidity Levels in the Gastric Tube After Esophagectomy for Esophageal Cancer.
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Kadoya K, Tanaka T, Mori N, Matono S, Hino H, Nishida R, Saisho K, Fujisaki M, Komukai S, Yanagawa T, Fujita H, and Akagi Y
- Subjects
- Humans, Esophagectomy adverse effects, Gastrins, Ulcer complications, Ulcer surgery, Esophagitis, Peptic etiology, Esophagitis, Peptic surgery, Esophageal Neoplasms surgery, Esophageal Neoplasms complications, Helicobacter Infections complications, Helicobacter Infections surgery
- Abstract
Reflux esophagitis and gastric tube ulcer sometimes cause severe clinical problems in patients undergoing esophagectomy with gastric tube reconstruction. We previously reported that acidity in the gastric tube was decreased for 1 year after esophagectomy, and that lower acidity levels were associated with Helicobacter pylori (H. pylori) infection. However, the long-term changes in gastric acidity remain unknown. We aimed to investigate the long-term changes in gastric acidity after surgery. Eighty-nine patients who underwent esophagectomy with gastric tube reconstruction for esophageal cancer were analyzed. They underwent 24-hour pH monitoring, serum gastrin measurement, and H. pylori infection examination before surgery, at 1 month, 1 year, and 2 years after surgery. The gastric acidity at 1 month and 1 year after surgery was significantly lower than that before surgery (p=0.003, p=0.003). However, there was no difference in gastric acidity before and 2 years after surgery. The gas tric acidity in H. pylori-infected patients was significantly lower in comparison to non-infected patients at each time point (p=0.0003, p<0.0001, p<0.0001, p<0.0001, respectively). In H. pylori-infected patients, gastric acid ity was decreased for 1 year after surgery, and recovered within 2 years after surgery. However, no significant differences were observed in the acidity levels of non-infected patients during the 2-year follow-up period. The serum gastrin level increased after esophagectomy. The acidity levels in the gastric tube recovered within 2 years after surgery. Periodic endoscopy examination is recommended for early detection of acid-related disease, such as reflux esophagitis or gastric tube ulcer, after esophagectomy with gastric tube reconstruction.
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- 2023
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27. Small Bowel Evisceration Through a Perforated Stercoral Ulcer.
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Chopra A, Rothstein A, Mohamed Ahmed A, and Pannell S
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- Female, Humans, Middle Aged, Ulcer complications, Ulcer surgery, Intestine, Small, Constipation complications, Intestinal Perforation etiology, Colonic Diseases surgery
- Abstract
Stercoral ulcers are localized areas of loss of colonic mucosal integrity. They result from pressure necrosis of the colonic mucosa, secondary to chronic constipation and fecal inspissation. These ulcers are rare and, are associated with serious complications, including bleeding and perforation. We present the case of a 50-year-old woman who presented with small bowel evisceration through the anal canal secondary to extraperitoneal perforation of the rectum. The patient underwent emergent exploratory laparotomy with reduction of the bowel, followed by second look laparotomy in 24 hours. A full thickness defect in the rectum was identified and Hartmann's procedure was performed. The patient's postoperative course was uneventful. Extraperitoneal perforation and evisceration of bowel is a rare clinical entity. These cases are diagnosed early due to the obvious clinical presentation and however may be misdiagnosed as prolapse. They necessitate urgent and careful surgical planning, to ensure preservation of bowel and complete recovery.
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- 2023
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28. Solitary Rectal Ulcer Syndrome Coexisting with Colitis Cystica Profunda-Is Mucosal Resection Radical or Not?
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Zhang Y, Tian F, and Li H
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- Humans, Ulcer complications, Ulcer surgery, Rectum surgery, Rectal Diseases complications, Rectal Diseases surgery, Colonic Diseases, Colitis complications, Colitis surgery
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- 2023
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29. A novel tetra-PEG based hydrogel for prevention of esophageal stricture after ESD in a porcine model.
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Wei Y, Tang J, Li J, Hou X, Li L, Zhang D, Chai D, Zhao M, and Liu F
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- Female, Swine, Animals, Constriction, Pathologic, Hydrogels pharmacology, Ulcer pathology, Ulcer surgery, Biocompatible Materials, Fibrosis, Esophageal Stenosis etiology, Esophageal Stenosis prevention & control, Esophageal Stenosis pathology, Endoscopic Mucosal Resection adverse effects
- Abstract
Endoscopic submucosal dissection (ESD) is an accepted treatment for early esophageal cancer and precancerous lesions, but resection of a large mucosal area often leads to postoperative esophageal stricture. Biomaterials provide a new option for the treatment of post-ESD ulcers. In this study, we developed a well-defined ammonolysis-based tetra-armed poly (ethylene glycol) (Tetra-PEG) hydrogel and investigated its efficacy and related mechanisms for preventing esophageal ESD-induced stricture in a porcine model. In terms of material properties, Tetra-PEG hydrogel present great biocompatibility,great capability to retain moisture, strong tissue adhesion and high mechanical strength. Then, six domestic female pigs were randomly divided into PEG (n = 3) and control groups (n = 3). A 3/4 of the esophageal circumference ESD was performed in all pigs. In PEG group, Tetra-PEG hydrogel was easily delivered via endoscopy and adhered to the ulcer bed tightly. Compared to control group, Tetra-PEG hydrogel accelerated esophageal ulcer healing at an early stage with enhanced epithelium regeneration, milder inflammation and lesser fibrosis by regulating TGF-β/Smad2 signaling. Taken together, our findings reveal Tetra-PEG hydrogel is a promising and attractive candidate for preventing the formation of fibrotic stricture in the process of esophageal ESD-induced ulcer repair., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)
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- 2023
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30. Successful management of 30 kg Gigantic para-testicular liposarcoma.
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Aksoy C, Karschuck P, Derigs M, Sevinc S, Groeben C, Zacharis A, Flegar L, Pehl A, Huber J, and Mandal S
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- Male, Humans, Middle Aged, Orchiectomy, Ulcer surgery, Testicular Neoplasms surgery, Testicular Neoplasms pathology, Liposarcoma diagnostic imaging, Liposarcoma surgery, Liposarcoma pathology
- Abstract
We report the successful management of a paratesticular liposarcoma, which, to the best of our knowledge, is the largest known of its type. A 62-year-old male presented with a painless, gradually progressive left testicular "giant" mass measuring 60 × 40 cm, weighing 30 kg and growing over a period of three 3 years. Additionally, a 5 × 5 cm trophic ulcer could be seen at the bottom of the scrotum. The ultrasound of the left testis revealed the testis having been completely replaced with a cystic and solid tumour. Preoperative serum testicular tumour markers (STM) were within normal limits. The markers included Alpha Feto Protein, Beta Human Chorionic Gonadotropin and Lactose Dehydrogenase. A left sided high inguino-scrotal approach with a huge skin resection including the trophic ulcer with complete removal of the tumour and a primary complex closure of the wound was performed. The post-operative period was uneventful, and histopathology revealed a dedifferentiated liposarcoma. We believe social taboo and fear of disfigurement impart a sense of shame in patients which led to the delayed presentation in a hospital in the index patient. The absence of metastases even with a protracted course is surprising., (© 2023. The Author(s).)
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- 2023
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31. Outcomes of endovascular repair of infrarenal penetrating aortic ulcers.
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Hatzl J, Behrendt CA, Schmitz-Rixen T, Grundmann RT, Steinbauer M, Böckler D, and Uhl C
- Subjects
- Aged, 80 and over, Humans, Female, Aged, Male, Endoleak etiology, Ulcer diagnostic imaging, Ulcer surgery, Ulcer complications, Treatment Outcome, Retrospective Studies, Risk Factors, Postoperative Complications, Penetrating Atherosclerotic Ulcer, Blood Vessel Prosthesis Implantation adverse effects, Aortic Aneurysm, Abdominal surgery, Endovascular Procedures adverse effects
- Abstract
Background: To report technical success as well as perioperative outcomes of patients who underwent endovascular aortic repair (EVAR) of penetrating abdominal aortic ulcers ≤35 mm in diameter (PAU). Patients and methods: The abdominal aortic aneurysm (AAA) quality registry of the German institute for vascular research (DIGG) was used to identify patients with standard EVAR for infrarenal PAU ≤35 mm between 1/1/2019 and 12/31/2021. Infectious, traumatic, inflammatory PAUs, PAUs associated with connective tissue disease, PAUs following aortic dissection as well as true aneurysms were excluded. Demographics, cardiovascular comorbidity, technical success as well as perioperative morbidity and mortality were determined. Results: Amongst 11 537 patients who underwent EVAR during the study period, 405 with PAU ≤35 mm were eligible from 95 participating hospitals across Germany (22% women, 20.5% octogenarians). The median aortic diameter was 30 mm (Interquartile range 27-33). Cardiovascular comorbidities were frequent with coronary artery disease (34.8%), chronic heart failure (30.9%), history of myocardial infarction (19.8%), hypertension (76.8%), diabetes (21.7%), smoking (20.8%), history of stroke (9.4%), symptomatic lower extremity peripheral arterial disease (20%), chronic kidney disease (10.4%) and chronic obstructive pulmonary disease (9.6%). Most patients were asymptomatic (89.9%). Among the symptomatic patients, 13 presented with distal embolization (3.2%) and 3 with contained ruptures (0.7%). Technical success of endovascular repair was 98.3%. Both, percutaneous (37.1%) or femoral cut-down access approaches (58.5%) were registered. Endoleaks of any type were present with type 1 (0.5%), type 2 (6.4%) and type 3 (0.3%) endoleaks. Overall mortality was 0.5%. Perioperative complications occurred in 12 patients (3.0%). Conclusions: According to this registry data, endovascular repair of PAU is technically feasible with acceptable perioperative outcomes, but further studies investigating mid- and long-term data are needed before invasive treatment of PAU disease in an elderly and comorbid patient population should be recommended.
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- 2023
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32. Perforated Ulcer of the Gastrojejunal Anastomosis and Concomitant Internal Hernia After One Anastomosis Gastric Bypass.
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Liagre A, Martini F, and Petrucciani N
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- Humans, Female, Adult, Ulcer complications, Ulcer surgery, Internal Hernia complications, Internal Hernia surgery, Gastric Bypass adverse effects, Gastric Bypass methods, Obesity, Morbid surgery, Laparoscopy methods, Hernia, Abdominal surgery, Peritonitis etiology
- Abstract
Purpose: The management of concomitant complications after OAGB is challenging. We aim to show the surgical management of two concomitant complications after one anastomosis gastric bypass: internal hernia and anastomotic ulcer perforation., Materials and Methods: We present the case of a 32-year-old woman with BMI of 51 kg/m2, who underwent OAGB. Three years later, she presented with intense and brutal epigastric pain. She was a heavy smoker. Her weight and BMI were 75 kg and 26 kg/m
2 , respectively. Clinical examination showed generalized peritonitis, computed tomography showed pneumoperitoneum, diffuse peritoneal effusion, and rotation of the superior mesenteric vessels indicative of an internal hernia., Results: A generalized biliary peritonitis secondary to a perforated ulcer on the gastrojejunal anastomosis and internal hernia of the common loop into a large Petersen orifice were diagnosed. The internal hernia was reduced, and a perforation of the posterior surface of the gastrojejunal anastomosis was identified. Surgical treatment consisted in the placement of a Kehr's drain into the perforation, closure of the Petersen orifice, and lavage-drainage of the peritoneal cavity. The postoperative course was uneventful, and she was discharged on postoperative day 12. The Kehr's drain was removed 1 month after discharge., Conclusion: The combination of two different complications after OAGB can make the pre- and intra-operative judgment difficult and hamper the therapeutic approach. The initial reduction of the internal hernia made it possible to reduce the pressure in the surgical assembly and facilitated the treatment of the anastomotic perforation., (© 2023. The Author(s).)- Published
- 2023
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33. Penetrating Ulcer of Ascending Aorta: a Life Threatening Incidentaloma.
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Campisi S and Ahmed SB
- Subjects
- Humans, Aorta, Thoracic, Aorta diagnostic imaging, Aorta surgery, Ulcer diagnostic imaging, Ulcer surgery, Penetrating Atherosclerotic Ulcer, Aortic Diseases complications, Aortic Diseases diagnostic imaging, Aortic Diseases surgery
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- 2023
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34. Laparoscopic versus open repair of perforated peptic ulcers: analysis of outcomes and identification of predictive factors of conversion.
- Author
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Tartaglia D, Strambi S, Coccolini F, Mazzoni A, Miccoli M, Cremonini C, Cicuttin E, and Chiarugi M
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- Humans, Retrospective Studies, Ulcer complications, Ulcer surgery, Risk Factors, Length of Stay, Postoperative Complications etiology, Treatment Outcome, Peptic Ulcer Perforation surgery, Peptic Ulcer Perforation etiology, Laparoscopy adverse effects
- Abstract
Background: The surgical treatment for perforated peptic ulcers (PPUs) can be safely performed laparoscopically. This study aimed to compare the outcomes of patients who received different surgical approaches for PPU and to identify the predictive factors for conversion to open surgery., Methods: This retrospective study analyzed patients treated for PPUs from 2002 to 2020. Three groups were identified: a complete laparoscopic surgery group (LG), a conversion to open group (CG), and a primary open group (OG). After univariate comparisons, a multivariate analysis was conducted to identify the predictive factors for conversion., Results: Of the 175 patients that underwent surgery for PPU, 104 (59.4%) received a laparoscopic-first approach, and 27 (25.9%) required a conversion to open surgery. Patients treated directly with an open approach were older (p < 0.0001), had more comorbidities (p < 0.0001), and more frequently had a previous laparotomy (p = 0.0001). In the OG group, in-hospital mortality and ICU need were significantly higher, while the postoperative stay was longer. Previous abdominal surgery (OR 0.086, 95% CI 0.012-0.626; p = 0.015), ulcer size (OR 0.045, 95% CI 0.010-0.210; p < 0.0001), and a posterior ulcer location (OR 0.015, 95% CI 0.001-0.400; p = 0.012) were predictive factors for conversion to an open approach., Conclusion: This study confirms the benefits of the laparoscopic approach for the treatment of PPUs. Previous laparotomies, a greater ulcer size, and a posterior location of the ulcer are risk factors for conversion to open surgery during laparoscopic repair., (© 2022. The Author(s).)
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- 2023
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35. A One-Size-Fits-All Approach to Pressure Ulcers: Whole-Buttock Fasciocutaneous Advancement Flap.
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Chen J, Chen JA, Chen CC, Yang YH, Teklu YE, Chang LR, and Feng KM
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- Humans, Ulcer surgery, Buttocks surgery, Surgical Flaps surgery, Treatment Outcome, Plastic Surgery Procedures, Pressure Ulcer surgery
- Abstract
Background: Buttock pressure injuries can be difficult to treat. There are many choices of flaps to reconstruct these wounds, but few are large, technically simple, and easily recycled., Aim and Objective: We are presenting our experience on surgical reconstruction of buttock pressure injuries using large whole-buttock fasciocutaneous flaps that are easily designed for ulcers regardless of location and size and are easily recycled for treatment of recurrences., Material and Methods: We conducted a retrospective review of all patients who received reconstruction with fasciocutaneous rotational flaps for buttock region pressure injuries from January 2013 to December 2018. The key steps of this one-size-fits-all flap include elevation of a large, oversized flap to achieve tension-free closure, avoiding fascial incisions over bony prominences, placing the V-Y type closure wound in the posteromedial thigh, and the use of closed incisional negative wound therapy postoperatively., Results: Fifty patients underwent 54 flaps reconstruction for coverage of stage 4 gluteal pressure injuries between January 2013 and December 2018. Seventy-four percent healed without the need for further operation. The average size of the defect was 90 cm2 (maximum = 300 cm2). The average follow-up period was 31 months. Four of the 54 flaps were "recycled" flaps, 3 were performed for the coverage of recurrent ulcers and 1 flap was performed for treatment of a postoperative wound dehiscence., Conclusions: We recommend this simple, one-size-fits-all approach, whole-buttock fasciocutaneous flap when surgically treating gluteal pressure injuries for selected patients., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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36. Perforated Stress Ulcer of the Duodenum: a Case of an Unexpected Diagnosis in a COVID-19 Patient Following Dilatation and Curettage Procedure.
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Obeidat N, Heilat G, Ajam T, and Al-Zoubi H
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- Humans, Pregnancy, Female, Adult, Ulcer complications, Ulcer surgery, Critical Illness, Duodenum, Dilatation and Curettage adverse effects, COVID-19 Testing, Intestinal Perforation surgery, COVID-19 complications, Duodenal Ulcer complications, Duodenal Ulcer surgery, Stomach Ulcer, Peptic Ulcer Perforation diagnosis, Peptic Ulcer Perforation etiology, Peptic Ulcer Perforation surgery
- Abstract
Background: Stress ulcers in the upper gastrointestinal tract can arise from pathologies related to erosive or inflammatory insults in critically ill patients. The relationship between stressful bodily events and the ischemia and perforation of stress ulcers is poorly understood., Objective: We present a case of perforated stress ulcer following an abortion that was treated by dilatation and curettage (D&C) and complicated by a coronavirus disease 2019 (COVID-19) infection., Case Presentation: A 40-year-old lady presented to the emergency room complaining of diffuse abdominal pain, she was recently diagnosed with an incomplete abortion and managed via a D&C procedure in an external hospital. A computed tomography (CT) scan was done at our center for the abdomen and pelvis, showing extensive pneumoperitoneum, which brought the radiologist's attention to suspect a small bowel perforation presumably accompanying a uterine perforation secondary to the D&C. There were no obvious signs of pelvic small bowel perforation in the initial CT images. The perforated duodenal stress ulcer was diagnosed the next day by a new CT scan following oral contrast ingestion and managed surgically by repair and omental patch, and no other bowel perforations were found upon surgical exploration. After the surgery, the patient was diagnosed with COVID-19, and her clinical status deteriorated gradually during the following week, and she passed away from a cardiac arrest., Conclusion: It is unclear whether septic abortion or COVID-19 has resulted in stress ulcer perforation in our patient. This case report highlights the importance of raising early suspicion in the diagnosis of stress ulcer perforation in critically ill patients to reduce the risk of morbidity and mortality., Competing Interests: The authors declare that they have no competing interests., (© 2023 Naser Obeidat, Ghaith Heilat, Tarek Ajam, Hamzeh Al-Zoubi.)
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- 2023
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37. Vonoprazan vs. Lansoprazole for the treatment of endoscopic submucosal dissection induced gastric ulcer: a systematic review and meta-analysis.
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Miao T, Zhang Y, Bai L, Yang X, and Wen X
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- Humans, Lansoprazole therapeutic use, Ulcer drug therapy, Ulcer etiology, Ulcer surgery, Proton Pump Inhibitors therapeutic use, Stomach Ulcer drug therapy, Stomach Ulcer etiology, Stomach Ulcer surgery, Endoscopic Mucosal Resection adverse effects, Stomach Neoplasms
- Abstract
Background: Vonoprazan is a potassium competitive acid blocker (P-CAB) approved in Japan in 2014 to treat endoscopic submucosal dissection (ESD)-induced ulcers and bleeding or perforation. Therefore, this meta-analysis aimed to determine whether Vonoprazan is more effective than Lansoprazole in the treatment of ESD-induced ulcers which include ulcer healing and shrinking rate, among others., Methods: Randomized controlled trials (RCT) and retrospective studies were collected from the PubMed (Medline), Embase, Web of science and Cochrane Library databases. Meanwhile, studies were selected according to predetermined qualification criteria and data were extracted by two researchers. The quality of the methods for published papers was evaluated using the modified Jadad scale., Results: Five studies were included in this meta-analysis, the ulcer healing rate effect was not significantly higher in the intervention groups than in the control groups at 4 weeks, [OR:1.07 (0.51, 2.22), 95% CI, I2=2%, Z=0.18, P=0.86]. There was no significant difference in the ulcer shrinkage rate at 4 weeks [MD:0.20 (-1.51, 1.92), 95% CI, I2=0%, P=0.82] and 8 weeks [MD: -0.09 (-0.30, 0.12), 95% CI, I2=0%, P=0.39]., Conclusion: There was no significant difference between Vonoprazan and Lansoprazole in the ulcers induced by treatment after 4 weeks and 8 weeks of treatment with ESD.
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- 2023
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38. Complications after pressure ulcer surgery – a study of 118 operations in spinal cord injured patients
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Ebba K. Lindqvist, Pehr Sommar, Jakob Lagergren, and Madeleine C Stenius
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,030230 surgery ,Surgical Flaps ,Cohort Studies ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Thinness ,Risk Factors ,medicine ,Humans ,Spinal cord injury ,Serum Albumin ,Spinal Cord Injuries ,Aged ,Retrospective Studies ,Aged, 80 and over ,Paraplegia ,Pressure Ulcer ,Wound Healing ,Ulcer surgery ,business.industry ,Age Factors ,Middle Aged ,Overweight ,medicine.disease ,Spinal cord ,Surgery ,Plastic surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Complication ,business - Abstract
Our aim in this study was to examine which factors are associated with post-operative complications after surgery for pressure ulcers in individuals with spinal cord injury. We performed a retrospective cohort study including all spinal cord injured patients undergoing pressure ulcer surgery in our department between 2002 and 2019. Patient demographics and comorbidity were collected from medical records, as were treatment data and information on post-operative complications within 30 days. Assessment of outcomes was performed through
- Published
- 2020
39. The use of mathematically standardized bilobed design perforator flaps for coverage of sacral pressure ulcers.
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Özkan B, Albayati A, Tatar BE, and Uysal CA
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- Humans, Male, Female, Middle Aged, Ulcer surgery, Lower Extremity surgery, Pressure Ulcer surgery, Perforator Flap surgery, Plastic Surgery Procedures
- Abstract
Background: Sacral pressure ulcer reconstruction is frequently applied in plastic surgery practice. Although perforator flaps are frequently used, recurrence is not uncommon in patients. For this reason, using the as little area as possible during the reconstruction is vital. Therefore, we aimed to describe a mathematically standardized bilobed perforator flap design for sacral pressure ulcer reconstruction with a certain proportion and angle relation between limbs., Methods: A total of 17 patients (5 female/12 male)were included in this report. The mean age of the patients was 50.4 years (Ranging from 32 to 79 years). The patients with grade 3-4 sacral pressure ulcers were included in the report. The patients have grade 1-2 sacral ulcers or the other areas of pressure ulcer excluded. The size of the defects ranged from 8 × 14 cm to 5 x 16 cm. For ulcers in the sacral region, we used bilobed flaps that we mathematically standardized. The length of the first limb of the flap was planned 90° vertically oriented according to the distance between the perforator zone to the distal lateral border of the defect. The width of the first limb was kept equal to the length of the defect. The orientation of the second limb of the flap was designed 90 degrees horizontally according to the first limb. Therefore, the lengths of second limbs were calculated as half of the first limb's width, and the widths of second limbs were calculated as ¾ width of the first limb's width., Results: A total of 10 flaps were elevated based on superior gluteal artery perforators, and seven flaps were nourished by inferior gluteal artery perforators. The mean size of the first limb of the flaps was 14.7 × 7.2 cm (Ranging from 8 to 20 × 6 to 13 cm). The mean size of the second limb of the flaps was 6.7 × 5.3 cm (Ranging from 5 to 12 × 4 to 8 cm). The mean size of defects was 10.5 × 7.3 cm (Ranging from 8 to 14 × 5 to 16). The mean rotation angle was 91.7° (ranging from 90 to 100). In the early postoperative period, the hematoma was detected in three patients and evacuated in one patient, resulting in wound separation. Tip necrosis was seen in a patient that was healed by wound care. No total flap loss was encountered. No late-term recurrence was seen during the follow-up. The mean follow-up time was 13.1 months (Ranging from 4 to 24 months)., Conclusion: Unilateral standardized bilobed perforator can reliably be preferred in medium to large size sacral pressure ulcer defects., (© 2022 Wiley Periodicals LLC.)
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- 2023
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40. C-DU(KE) Calculator: A Clinical Tool for Risk Stratification in Infectious Keratitis.
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Mousa HM, Feghali J, Song A, Soifer M, Jammal AA, and Perez VL
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- Adult, Humans, Retrospective Studies, Ulcer surgery, Keratoplasty, Penetrating, Risk Assessment, Keratitis microbiology, Corneal Ulcer microbiology
- Abstract
Purpose: The aim of this study was to identify characteristics of infectious keratitis predictive of poor outcome to develop a web-based predictive calculator., Method: A retrospective chart review was performed at the Duke Eye Center. Two hundred fifteen adult patients with culture-proven infectious keratitis presenting between January 1, 2016, and December 31, 2020, were separated into a derivation set (136 patients, 53 positives; 83 controls) and a temporal validation set (79 patients, 26 positives; 53 controls). The poor outcome group consisted of patients requiring penetrating keratoplasty for visually significant scarring, penetrating keratoplasty for ulcer progression, or evisceration/enucleation for endophthalmitis. Univariable analysis was performed followed by stepwise multivariable logistic regression to obtain a predictive model in the derivation data set. Culture-naïve and postculture models were constructed. Discrimination and calibration were assessed using the area under the curve (AUC) and calibration plots, respectively., Results: The culture-naïve model consisted of corticosteroid drop use postsymptom onset [Odds Ratio (OR) = 2.3, P = 0.054], decreased vision (OR = 2.4, P = 0.001), and increased ulcer area (OR = 1.017, P = 0.017). The postculture model additionally included fungal keratitis (OR = 5.4, P = 0.006) and elapsed time from symptoms to organism-sensitive therapy (OR = 1.027, P = 0.014). The models were summarized by the acronym C-DU(KE). The AUCs for the culture-naïve model were 0.794 in the derivation set and 0.850 in the validation set. The AUCs for the postculture model were 0.898 in the derivation set and 0.946 in the validation set. Calibration plots indicated goodness of fit in the data sets for both models. The calculator was deployed under the URL: https://duke-eye-calculator.shinyapps.io/Corneal_Ulcers/ ., Conclusions: The C-DU(KE) calculator permits a data-driven prediction of outcome in infectious keratitis that can supplement clinical judgment., Competing Interests: V. L. Perez—Alcon, Dompe, EyeGate, Kala, Trefoil, Novartis, Oculis, National Institutes of Health/National Eye Institute R01EY030283 (V.L.P.) and R01EY024485 (V.L.P.), Duke NIH Center Core Grant, and Duke Research to Prevent Blindness Unrestricted Grant (V.L.P.). The remaining authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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41. Outcomes of Partial Calcanectomy in an Academic Limb Salvage Center: A Multicenter Review.
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Ravine M, Kumaravel S, Dini M, Parks C, Shader SW, Shih CD, Vartivarian M, Guo A, and Reyzelman A
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- Humans, Ulcer surgery, Retrospective Studies, Heel surgery, Treatment Outcome, Limb Salvage methods, Calcaneus surgery
- Abstract
Chronic nonhealing heel ulcerations have been established as an independent risk factor for major amputation, with poor rates of limb salvage success. Partial calcanectomy is a controversial limb salvage procedure reserved for patients with these heel ulcerations. We conducted a retrospective cohort study reviewing 39 limbs that underwent a partial calcanectomy from 2012 to 2018 to evaluate the proportion of patients healed, time to healing, ulcer recurrence, and postoperative functional level compared to the preoperative state. In addition, age, gender, body mass index, smoking status, coronary artery disease, diabetes mellitus, renal insufficiency, dialysis, peripheral arterial disease, method of closure, and percent of calcaneus resected were evaluated. Mean follow-up for our cohort was 2.3 years. We had a 1 year mortality rate of 11%, and a major amputation rate of 18%. Our results demonstrated a 77% healing rate with a median time to healing of 162 days. We found that patients who were closed primarily had a faster time to healing compared to patients who underwent closure by secondary intention. Our data showed that ulcer recurrence developed in 57% of healed limbs. We found that 76% of our patients were ambulatory postoperatively. These results suggest that partial calcanectomy is a viable limb salvage procedure with a predictable level of ambulation and function in a high-risk patient population., (Copyright © 2022 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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42. Outcomes of Keller Gap Arthroplasty for Plantar Hallux Interphalangeal Joint Ulcers in Patients With Diabetes Mellitus.
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Periasamy M, Muthukumar V, Mali Reddy R, Asokan K, and Sabapathy SR
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- Humans, Ulcer complications, Ulcer surgery, Retrospective Studies, Cohort Studies, Prospective Studies, Arthroplasty methods, Follow-Up Studies, Hallux surgery, Foot Ulcer, Diabetic Foot surgery, Metatarsophalangeal Joint surgery, Diabetes Mellitus
- Abstract
Background: Hallux ulcers are known for their recurrence and associated risk for future amputations. Traditional nonsurgical external offloading methods have poor compliance rates, and the data is sparse on surgical offloading of hallux ulcers. We performed this study to analyze the outcomes of Keller excision gap arthroplasty of the first metatarsophalangeal joint in patients with a neuropathic plantar hallux interphalangeal joint (IPJ) ulcer in patients with diabetes mellitus., Methods: A retrospective study of 105 diabetic patients with a plantar hallux IPJ ulcer who underwent a Keller excision gap arthroplasty between December 2014 and June 2020 was done. A total of 122 great toes had been operated upon for hallux IPJ ulcers. We studied the long-term wound healing rates from patient records and then did a prospective survey of the postreview period., Results: All the hallux IPJ ulcers healed well in the immediate postoperative period. Six patients reported a recurrence of the ulcer at the original site during a mean follow-up period of 30 months. For these 6 patients, the mean time to recurrence of ulcer after operation was 2.5 years., Conclusion: At an average of 30 months, we found the Keller gap arthroplasty for treatment of noninfected and nonischemic diabetic foot hallux IPJ ulcers was associated with an ulcer recurrence rate of 5%., Level of Evidence: Level IV, cohort study.
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- 2023
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43. Ulcer Scarring in the Gastric Conduit Is a Risk Factor for Anastomotic Leakage After Esophagectomy for Esophageal Cancer.
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Motegi D, Ichikawa H, Bamba T, Muneoka Y, Kano Y, Usui K, Hanyu T, Ishikawa T, Hirose Y, Miura K, Tajima Y, Shimada Y, Sakata J, Nakagawa S, Kosugi SI, and Wakai T
- Subjects
- Humans, Esophagectomy adverse effects, Esophagectomy methods, Cicatrix etiology, Ulcer complications, Ulcer surgery, Stomach blood supply, Indocyanine Green, Risk Factors, Anastomosis, Surgical adverse effects, Anastomotic Leak etiology, Anastomotic Leak surgery, Esophageal Neoplasms etiology
- Abstract
Background: Anastomotic leakage (AL) is a serious complication after esophagectomy for esophageal cancer. The objective of this study was to identify the risk factors for AL., Methods: Patients with esophageal cancer who underwent curative esophagectomy and cervical esophagogastric anastomosis between 2009 and 2019 (N = 346) and those between 2020 and 2022 (N = 17) were enrolled in the study to identify the risk factors for AL and the study to assess the association between the risk factors and blood flow in the gastric conduit evaluated by indocyanine green (ICG) fluorescence imaging, respectively., Results: AL occurred in 17 out of 346 patients (4.9%). Peptic or endoscopic submucosal dissection (ESD) ulcer scars were independently associated with AL (OR 6.872, 95% CI 2.112-22.365) in addition to diabetes mellitus. The ulcer scars in the anterior/posterior gastric wall were more frequently observed in patients with AL than in those without AL (75.0% vs. 17.4%, P = 0.042). The median flow velocity of ICG fluorescence in the gastric conduits with the scars was significantly lower than in those without the scars (1.17 cm/s vs. 2.23 cm/s, P = 0.004)., Conclusions: Peptic or ESD ulcer scarring is a risk factor for AL after esophagectomy in addition to diabetes mellitus. The scars in the anterior/posterior gastric wall are significantly associated with AL, impairing blood flow of the gastric conduit. Preventive interventions and careful postoperative management should be provided to minimize the risk and severity of AL in patients with these risk factors., (© 2022. The Society for Surgery of the Alimentary Tract.)
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- 2023
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44. Impact of the underlying aortic pathology on postimplantation syndrome after endovascular thoracic aortic repair.
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Volevski LA, Vasiloi I, Abudureheman N, Talipov I, König A, Dielmann K, Glück AC, and Andrási TB
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- Humans, Blood Vessel Prosthesis, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Retrospective Studies, Ulcer diagnostic imaging, Ulcer surgery, Ulcer complications, Inflammation complications, Inflammation surgery, Treatment Outcome, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures adverse effects, Aortic Dissection diagnostic imaging, Aortic Dissection surgery, Aortic Aneurysm surgery, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic complications
- Abstract
Background: Thoracic endovascular aortic repair (TEVAR) is the treatment option of choice for almost all pathologies of the descending thoracic aorta. The aim of the present study was to determine the impact of aortic pathology on the occurrence of postimplantation syndrome (PIS) after TEVAR., Methods: Seventy-four patients undergoing TEVAR for aortic dissection (TAD, 25), aortic aneurysm (TAA, 26), and aortic rupture or perforated ulcer (TAR/PAU, 23) were included in this retrospective study. The clinical outcome measures were persistent inflammation at hospital discharge and in-hospital mortality., Results: PIS was assessed in 22.97% of all patients, predominantly in the TAD group (P=0.03). CRP increased after TEVAR (156.6±94.5, P<0.001; 108.1±57.7, P<0.01 and 117.8±70.4, P<0.05) vs. baseline (58.1±77.5, 31.94±52.1 and 31.9±52.1 mg/L, in TAD, TAA and TAR/PAU, respectively) and this increase was more accentuated in TAD group (P<0.05). Stent-length was similar in all groups (P=0.226) but correlated with postoperative CRP only in TAD (R=0.576, P=0.013). Fresh parietal thrombus correlated with CRP (R=0.4507, P=0.0005) and is (OR=1.0883, P=0.0001), together with the pathology of aortic dissection (OR=6.2268, P=0.0288), a predictor of PIS after TEVAR. Whereas mortality (5.4%) did not correlate with PIS (P=0.38) either with aortic pathology (P=0.225), hospital stay after TEVAR was significantly prolonged by PIS (P=0.03)., Conclusions: Aortic dissection is associated with more inflammation after TEVAR than aortic aneurysm, rupture or perforated ulcer, with the amount of fresh parietal thrombus playing the most significant role in the occurrence of PIS. Importantly, PIS prolongs hospital stay but not mortality after TEVAR.
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- 2023
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45. Midterm Outcomes of Endovascular Therapy for TASC II D Femoropopliteal Lesions with Critical Limb Ischemia: A Retrospective Analysis.
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Liu P, Zheng LH, He XQ, Yang Y, Zhang LK, Zhang L, and Zhang F
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- Humans, Middle Aged, Aged, Popliteal Artery, Retrospective Studies, Chronic Limb-Threatening Ischemia, Ulcer surgery, Vascular Patency, Treatment Outcome, Femoral Artery surgery, Limb Salvage, Constriction, Pathologic etiology, Ischemia diagnostic imaging, Ischemia therapy, Endovascular Procedures adverse effects, Endovascular Procedures methods, Vascular Diseases surgery
- Abstract
Background: This study evaluated the midterm results of endovascular therapy (EVT) for Trans-Atlantic Inter-Society (TASC) II D femoropopliteal lesions in patients with critical limb ischemia (CLI)., Methods: Fifty seven limbs of 54 patients with CLI due to TASC II D femoropopliteal lesions who underwent EVT at the First Hospital of Hebei Medical University were retrospectively analysed in a single-centre, observational study. The patient characteristics, endovascular procedural details, freedom from target lesion revascularization (TLR), patency rates, ulcer healing rate, and limb salvage rate were accessed., Results: The patients' mean age was 68.2 ± 8.2 years. All patients were treated by EVT. The final technical success rate was 98.2% (56/57). There were 23 cases of pain at rest, 18 cases of ulcer, and 15 cases of gangrene. The median length of the treated segment was 286 ± 42 mm (56/56) and the mean number of stents placed per patient was 2.0 ± 0.8 (49/56). The postoperative ankle-brachial index was significantly higher than that of the preoperative ankle-brachial index (P < 0.05). The perioperative complication rate was 10.7% (6/56). The restenosis or occlusion rate was 44.6% (25/56). The estimated rates of freedom from TLR at 1 year, 2 years, and 3 years were 86.8%, 67.0%, and 62.5%, respectively. A univariate analysis showed that predictors of freedom from TLR were the number of runoff vessels, length of the lesion, and complexity of the lesion, while predictors for restenosis or occlusion were the length and the complexity of the lesion. The ulcer healing rate was 93.8%. The limb salvage rates were 76.4%, 74.4%, and 70.9% at 1, 2, and 3 years after treatment, respectively., Conclusions: The midterm outcomes of EVT for TASC II D femoropopliteal lesions in patients with CLI indicated that this treatment approach is safe and effective and is clinically applicable., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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46. Midterm results of complicated penetrating abdominal aortic ulcer treated by aortobi-iliac endograft and embolization.
- Author
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Gallitto E, Faggioli G, Spath P, Ancetti S, Pini R, Logiacco A, Palermo S, and Gargiulo M
- Subjects
- Humans, Endoleak diagnostic imaging, Endoleak etiology, Endoleak therapy, Ulcer diagnostic imaging, Ulcer surgery, Treatment Outcome, Risk Factors, Blood Vessel Prosthesis adverse effects, Retrospective Studies, Blood Vessel Prosthesis Implantation, Aortic Aneurysm, Abdominal surgery, Endovascular Procedures
- Abstract
Background: Penetrating aortic ulcer (PAU) is determined by atherosclerotic degeneration of the tunica media with disruption of the intima. Usually it is detected in the thoracic aorta, with few series describing an abdominal location. The aim of the study was to report early and late outcomes of the endovascular repair of complicated infrarenal abdominal PAU (a-PAU) by aortobi-iliac endograft and embolization., Methods: Data from all complicated a-PAU submitted to endovascular repair by aortobi-iliac endograft (Cook-Zenith Alpha) between 2016 and 2021 (February) were analyzed. The a-PAU coil embolization was performed to decrease the risk of persistent type II endoleak whenever possible. Complicated a-PAU were defined according with the presence of symptoms, aortic rupture, or saccular or pseudo-aneurysm. Technical success, 30-day morbidity and mortality, and reinterventions were assessed as early outcomes. Survival, endoleaks, and freedom from reinterventions were evaluated during follow-up., Results: Of 1153 endovascular aortic procedures, 45 cases (4%) of complicated a-PAU were identified. Fourteen cases (31%) were managed in urgent setting (symptoms, n = 10 [22%]; shock, n = 4 [9%]). The median diameter of a-PAU was 49 mm (interquartile range, 14 mm). Thirteen patients (29%) had severe femoral or iliac access (angle >90°, circumferential calcification [>50%], hemodynamic iliac stenosis or obstruction, an external iliac artery diameter of less than 7 mm, or a previous femoral surgical graft). The a-PAU embolization was performed in 30 cases (67%). Technical success was achieved in all patients. Postoperative cardiac, pulmonary and renal morbidity occurred in one (2%), two (4%), and eight (18%) patients, respectively. Two patients (4%) required reintervention within 30 days for access related complications. The 30-day mortality was 2%. At a median follow-up of 24 months (interquartile range, 18 months), no type I or III endoleaks, iliac leg occlusion, or graft infection occurred and no patient required late reinterventions; the 36-month survival rate was 72%. No a-PAU enlarged or ruptured during follow-up., Conclusions: Endovascular repair of complicated a-PAU by a low-profile aortobi-iliac endograft and embolization is safe and effective. Excellent technical results are reported even in challenging anatomic features. Midterm clinical results are satisfactory in terms of aortic-related complications or mortality, freedom from reintervention, and survival., (Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2023
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47. Revision Gastrojejunostomy Versus Suturing With and Without Omental Patch for Perforated Marginal Ulcer Treatment After Roux-en-Y Gastric Bypass.
- Author
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Crawford CB, Schuh LM, and Inman MM
- Subjects
- Humans, Female, Adult, Middle Aged, Ulcer complications, Ulcer surgery, Retrospective Studies, Treatment Outcome, Gastric Bypass adverse effects, Gastric Bypass methods, Peptic Ulcer complications, Peptic Ulcer surgery, Bariatric Surgery adverse effects, Laparoscopy adverse effects, Obesity, Morbid surgery, Obesity, Morbid complications
- Abstract
Background: Ulceration at the gastrojejunostomy is a late bariatric surgery complication in 0.6-16% of Roux-en-Y gastric bypass (RYGB) patients. As there is no general consensus on management of acute ulcer perforations, we compare two methods of surgical repair: the most commonly performed procedure, suturing of ulcer with or without omental patch versus revision gastrojejunostomy (RG)., Methods: A retrospective chart review of cases at a single large, Midwestern US high-volume bariatric center from November 2, 2006 through March 11, 2021 identified 144 RYGB patients undergoing surgical repair for a perforated ulcer: 72 treated by SGP and 72 by RG. Outcomes, including length of stay, leaks, readmissions, and reoperations, were compared. Categorical variables were compared by Chi-square tests and continuous variables by ANOVA., Results: Patients were primarily female (77.1%) and Caucasian (97.2%), 49.7 ± 12.5 years old, and 90.6 ± 26.6 kg. Most had laparoscopic RYGBs (98.6%). There were no demographic differences between groups. Of the RG patients, 11.4% experienced ulcer recurrence versus 41.7% of SGP patients (p < .001), and 2.8% of RG versus 11.1% of SGP patients required a reversal (p < .05). No significant differences between groups occurred in time to perforation (3.2 vs. 2.5 years for RG and SGP groups, respectively), length of stay (5.0 vs. 6.8 days), leaks (1.4% vs. 2.8%), readmissions (4.2% vs. 4.2%), or reoperations (2.8% vs 5.6%)., Conclusions: Patients developing perforated marginal ulcers after RYGB can be safely and effectively treated by revision gastrojejunostomy with a lower likelihood of ulcer recurrence. Short-term morbidity was comparable to suturing with or without an omental patch., (© 2022. The Society for Surgery of the Alimentary Tract.)
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- 2023
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48. A national analysis of readmissions for wound healing complications following the repair of lower back, hip, and buttock pressure ulcers using the Nationwide Readmissions Database
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Jayant P. Agarwal, Willem Collier, Jaewhan Kim, Jacob Veith, and Alvin C. Kwok
- Subjects
Male ,Reoperation ,Databases, Factual ,030230 surgery ,computer.software_genre ,Patient Readmission ,Surgical Flaps ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Buttocks ,Pressure Ulcer ,Surgical repair ,Back ,Hip ,Database ,Wound Closure Techniques ,Ulcer surgery ,business.industry ,General Medicine ,Middle Aged ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Surgery ,business ,Wound healing ,computer - Abstract
Background Traditionally, a 30-day postoperative period is used to assess outcomes in surgery. However, it is not clear if this is sufficient. Our study assessed readmissions and their risk factors following the surgical repair of pressure ulcers in a 90-day postoperative period. Methods Patients with a pressure ulcer to the lower back, hip, and/or buttocks who underwent a pedicled or flap based wound operation were identified in the National Readmissions Database. We then analyzed risk factors for overall 0–90-day readmissions, early readmissions (0–30 days), and late-readmissions (31–90 days). Results 3329 patients were identified, of which 154 (4.66%) had surgical wound-related readmissions. A majority of these occurred after 30 days (53.89%). 90% of patients with a surgical-wound related readmission were readmitted within 63 days of index procedure. Conclusions The traditional 30-day outcome period is not enough to properly assess outcomes in pressure ulcer surgery such as readmission. We demonstrate that a period of at least 10 weeks and perhaps the entire global 90-day postoperative period would be more appropriate to evaluate readmissions after ulcer repair.
- Published
- 2019
49. Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction
- Author
-
Anthony Papp
- Subjects
Adult ,Male ,medicine.medical_specialty ,Demographics ,Open wounds ,medicine.medical_treatment ,Dermatology ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Cost Savings ,Risk Factors ,Negative-pressure wound therapy ,medicine ,Humans ,Surgical Wound Infection ,Complication rate ,Prospective Studies ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Pressure Ulcer ,Wound Healing ,Ulcer surgery ,business.industry ,Original Articles ,Middle Aged ,Plastic Surgery Procedures ,Cost savings ,Surgery ,Cohort ,Female ,business ,Hospital stay ,Negative-Pressure Wound Therapy - Abstract
Complications after pressure ulcer reconstruction are common. A complication rate of 21% to 58% and a 27% wound recurrence has been reported. The aim of this study was to decrease postoperative wound‐healing complications with incisional negative pressure wound therapy (iNPWT) postoperatively. This was a prospective non‐randomised trial with a historic control. Surgically treated pressure ulcer patients receiving iNPWT were included in the prospective part of the study (Treatment group) and compared with the historic patient cohort of all consecutive surgically treated pressure ulcer patients during a 2‐year period preceding the initiation of iNPWT (Control). There were 24 patients in the Control and 37 in the Treatment groups. The demographics between groups were similar. There was a 74% reduction in in‐hospital complications in the Treatment group (10.8% vs 41.7%, P = 0.0051), 27% reduction in the length of stay (24.8 vs 33.8 days, P = 0.0103), and a 78% reduction in the number of open wounds at 3 months (5.4 vs 25%, P = −0.0481). Recurrent wounds and history of previous surgery were risk factors for complications. Incisional negative pressure wound therapy shortens hospital stay, number of postoperative complications, and the number of recurrent open wounds at 3 months after reconstructive pressure ulcer surgery, resulting in significant cost savings.
- Published
- 2018
50. Complications and their associations following the surgical repair of pressure ulcers
- Author
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Jayant P. Agarwal, Isak A. Goodwin, Alvin C. Kwok, Andrew Simpson, James R. Willcockson, and Daniel P. Donato
- Subjects
Adult ,Male ,medicine.medical_specialty ,Surgical Flaps ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Diabetes mellitus ,Humans ,Medicine ,Complication rate ,030212 general & internal medicine ,National data ,Aged ,Retrospective Studies ,Pressure Ulcer ,Surgical repair ,business.industry ,Ulcer surgery ,General Medicine ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Obesity ,Surgery ,Hospitalization ,Survival Rate ,Treatment Outcome ,Increased risk ,Female ,business ,Elderly age - Abstract
Background Despite high expenditure, there is little national data on rates of complications following pressure ulcer repair. Complications, mortality and their predictors following surgical repair of pressure ulcers were evaluated. Methods Patients undergoing pressure ulcer repair were identified in the NSQIP database from 2005 to 2015. Regression models were used to identify risk factors for complications. Results 1248 cases were identified with a complication rate of 35.0%. Obesity was associated with increased risk of complications, whereas flap closure was associated with fewer complications. Thirty-day mortality was 3.3%. Elderly age and diabetes were associated with increased mortality. Conclusions Elderly age, diabetes and dependency are associated with increased mortality following pressure ulcer surgery. Flap repair is associated with decreased complications. Pressure ulcer reconstruction requires careful patient selection and surgical technique to mitigate risks and mortality.
- Published
- 2018
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