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Opioid prescribing practices in academic otolaryngology: A single institutional survey.

Am J Otolaryngol 2021 Apr 15;42(5):103038. Epub 2021 Apr 15.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.

Objectives: Opioids are highly addictive medications and otolaryngologists have a responsibility to practice opioid stewardship. We investigated postoperative opioid prescribing patterns among resident and attending physicians as an educational platform to underscore the importance of conscientious opioid prescribing.

Methods: This quality improvement study was designed as a cross-sectional electronic survey. Read More

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Early Clinical and Patient-Reported Outcomes of a New Hybrid Mesh for Incisional Hernia Repair.

J Surg Res 2021 Apr 17;265:49-59. Epub 2021 Apr 17.

Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address:

Introduction: Consensus on the safety and efficacy of various types of mesh in reconstructing the abdomen has yet to be reached. Hybrid mesh products have been designed to address the need for a cost-effective mesh leveraging the tensile strength of a synthetic mesh while minimizing the prosthetic footprint within the abdominal wall through resorbable materials. In this study we evaluate early clinical outcomes and health related quality of life (HR-QOL) of a new Hybrid mesh, Synecor, for Ventral Hernia Repair (VHR). Read More

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Locating the Rotator Cable during Subacromial Arthroscopy; Bursal- and Articular-Sided Anatomy.

J Shoulder Elbow Surg 2021 Apr 17. Epub 2021 Apr 17.

Shoulder and Elbow Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA.

Background: The rotator cable (RCa) is an important articular-sided structure of the cuff capsular complex that helps prevent suture pull out during rotator cuff repairs (RCR) and plays a role in force transmission. Yet, the RCa cannot be located during bursal-sided RCRs. The purpose of this study is to develop a method to locate the RCa in the subacromial space and compare its bursal- and articular-sided dimensions. Read More

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The Fate of Proximal Junctional Vertebral Fractures after Long-Segment Spinal Fixation : Are There Predictable Radiologic Characteristics for Revision surgery?

J Korean Neurosurg Soc 2021 Apr 21. Epub 2021 Apr 21.

Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.

Objective: To investigate the radiographic characteristics of the uppermost instrumented vertebrae (UIV) and UIV+1 compression fractures that are predictive of revision surgery following long-segment spinal fixation.

Methods: A total 27 patients who presented newly developed compression fracture at UIV, UIV+1 after long segment spinal fixation (minimum 5 vertebral bodies, lowest instrumented vertebra of L5 or distal) were reviewed retrospectively. Patients were divided into two groups according to following management : revisional surgery (group A, n=13) and conservative care (group B, n=14). Read More

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Long-term cognitive outcome after radiosurgery in epileptic hypothalamic hamartomas and review of the literature.

Epilepsia 2021 Apr 20. Epub 2021 Apr 20.

Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France.

Objective: Epileptic patients with hypothalamic hamartoma (HH) frequently present cognitive impairments. Surgical techniques aiming at HH can be very efficient for epilepsy relief and cognitive improvement but are also demonstrated to carry a significant risk of additional reduction in memory function in these already disabled patients. Gamma knife radiosurgery (GKS) offers an efficient minimally invasive procedure. Read More

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Intra-Operative Vascular Injury and Control During Laparoscopic and Robotic Mesh Explantation for Chronic Post Herniorrhaphy Inguinal Pain (CPIP).

Surg Technol Int 2021 Apr 20;38. Epub 2021 Apr 20.

Department of Surgery, David Geffen School of Medicine, Lichtenstein Amid Hernia Institute at UCLA Santa Monica, CA, USA.

Introduction: Chronic postherniorrhaphy inguinal pain (CPIP) is common following inguinal hernia repair. As even primary minimally-invasive inguinal hernia repairs carry a risk of significant intra-operative bleeding, it is unsurprising that reoperative groin exploration and mesh explantation for chronic post-inguinal herniorrhaphy pain confers an even higher risk of arteriotomy or venotomy due to a distorted anatomy and the presence of adhesions. In this report, we present a single institution's experience with the management of intra-operative vascular injury encountered during minimally invasive groin exploration and mesh explantation for CPIP. Read More

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Chemotherapy and Abdominal Wall Closure Technique Increase the Probability of Postoperative Ventral Incisional Hernia in Patients With Colon Cancer.

Am Surg 2021 Apr 20:31348211011149. Epub 2021 Apr 20.

Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Texas, USA.

Background: Chemotherapy is associated with postoperative ventral incisional hernia (PVIH) after right hemicolectomy (RHC) for colon cancer, and abdominal wall closure technique may affect PVIH. We sought to identify clinical predictors of PVIH.

Methods: We retrospectively analyzed patients who underwent RHC for colon cancer from 2008-2018 and later developed PVIH. Read More

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A Strategy for Integrative Reconstruction of Midface Defects Using an Extended Forehead Flap.

Facial Plast Surg Aesthet Med 2021 Apr 20. Epub 2021 Apr 20.

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.

Midface reconstruction is challenging because the structures and deformities involved are complicated. In this study, we present a strategy for integrally reconstructing nasal and midface defects, including hair-bearing defects, using extended forehead-expanded flaps. From 2015 to 2018, a total of 22 patients with midface defects underwent reconstruction with extended forehead-expanded flaps. Read More

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Neck Dissections Based on Sentinel Lymph Node Navigation Versus Elective Neck Dissections in Early Oral Cancers: A Randomized, Multicenter, and Noninferiority Trial.

J Clin Oncol 2021 Apr 20:JCO2003637. Epub 2021 Apr 20.

National Cancer Center Hospital, Tokyo, Japan.

Purpose: This study aimed to compare patients with early oral cavity squamous cell carcinoma (OCSCC) (tumor category [T] 1-2, node-negative, and no distant metastasis) treated with traditional elective neck dissection (ND) with those managed by sentinel lymph node biopsy (SLNB) using survival and neck function and complications as end points.

Methods: Sixteen institutions in Japan participated in the study (trial registration number: UMIN000006510). Patients of age ≥ 18 years with histologically confirmed, previously untreated OCSCC (Union for International Cancer Control TNM Classification of Malignant Tumors 7th edition T1-2, node-negative no distant metastasis), with ≥ 4 mm (T1) depth of invasion, were randomly assigned to undergo standard selective ND (ND group; n = 137) or SLNB-navigated ND (SLNB group; n = 134). Read More

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An extended distally based reverse posterior interosseous artery flap reconstruction for the thumb and distal defects of the fingers.

Microsurgery 2021 Apr 20. Epub 2021 Apr 20.

Department of Plastic Reconstructive Aesthetic Surgery, Osmangazi University, Faculty of Medicine, ESKİŞEHİR, Turkey.

Background: The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. Read More

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Pain distraction during awake low anterior resection and Cuddle Delivery initiative for inpatient: frugal procedural options to support surgery in the COVID-19 era.

Eur Rev Med Pharmacol Sci 2021 Apr;25(7):3116-3121

Department of General Surgery, Valduce Hospital, Como, Italy.

Objective: Since minimally invasive surgery and general anesthesia are both aerosol-generating procedures, their use became controversial during the outbreak of coronavirus disease 2019 (COVID-19). Moreover, social distancing resulted in serious psychological consequences for inpatients. This case report investigates pain distraction during awake laparotomy, as well as new possibilities for emotional postoperative support to inpatients. Read More

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Prognostic analysis of Behçet's disease with aortic regurgitation or involvement.

Neth Heart J 2021 Apr 20. Epub 2021 Apr 20.

Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.

Background: Aortic regurgitation is the most common cardiovascular damage in Chinese patients with Behçet's disease (BD) and is usually associated with aortic disease. These patients are easily misdiagnosed, and their prognosis is poor, even after surgical treatment. This study aimed to analyse potential factors that can improve the prognosis of BD patients with aortic regurgitation and/or aortic involvement. Read More

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Do Preoperative Esophageal pH Monitoring and High-Resolution Manometry Predict Symptoms of GERD After Sleeve Gastrectomy?

Obes Surg 2021 Apr 20. Epub 2021 Apr 20.

Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, Université de Paris, 75018, Paris, France.

Background: Predictive factors of evolution or appearance of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) have not been identified to date. We aimed to assess the evolution of GERD symptoms 1 year after SG and to determine preoperative predictive factors using high-resolution manometry (HRM) and ambulatory 24-h esophageal pH monitoring (APM).

Methods: We included 160 patients who underwent SG between 2013 and 2017 and performed preoperative APM and HRM. Read More

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The Effects of Laparoscopic Sleeve Gastrectomy on Cardiac Diastolic Function, Aortic Elasticity, and Atrial Electromechanics Delay.

Obes Surg 2021 Apr 20. Epub 2021 Apr 20.

Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.

Background: Obesity is a well-known risk factor for cardiovascular diseases. The aim of this study was to prospectively investigate the short-term effects of laparoscopic sleeve gastrectomy (LSG) on cardiac functions.

Methods: Forty-four morbidly obese patients who underwent LSG were included in the study. Read More

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Evaluation of the 'Spaarne soft tissue procedure' as a treatment for recurrent patellar dislocations: a four-in-one technique.

J Exp Orthop 2021 Apr 20;8(1):31. Epub 2021 Apr 20.

Department, of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.

Purpose: The 'Spaarne soft tissue procedure', is a 4-in-1 soft tissue procedure that treats recurrent patellar dislocations in the young and active population. The procedure has not yet described elsewhere. The purpose of this study is to analyse the redislocation rate and to evaluate the postoperative knee function and patient satisfaction. Read More

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Laparoscopic gastrectomy for stage II and III advanced gastric cancer: long‑term follow‑up data from a Western multicenter retrospective study.

Surg Endosc 2021 Apr 20. Epub 2021 Apr 20.

Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy.

Introduction: There has been an increasing interest for the laparoscopic treatment of early gastric cancer, especially among Eastern surgeons. However, the oncological effectiveness of Laparoscopic Gastrectomy (LG) for Advanced Gastric Cancer (AGC) remains a subject of debate, especially in Western countries where limited reports have been published. The aim of this paper is to retrospectively analyze short- and long-term results of LG for AGC in a real-life Western practice. Read More

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Trans-isthmic pars interarticularis screw fixation under CT and fluoroscopic guidance: technical success and clinical outcome in patients with symptomatic low-grade lumbar isthmic lysis.

Eur Radiol 2021 Apr 20. Epub 2021 Apr 20.

Interventional and Diagnostic Neuroradiology Unit, Grenoble University Hospital, Boulevard du Grésivaudan, 38000, Grenoble, France.

Objectives: To assess the technical success of trans-isthmic screw fixation with simultaneous CT and fluoroscopic guidance in patients with symptomatic low-grade isthmic spondylolisthesis.

Methods: Fifty patients (28 women and 22 men; mean age ± standard deviation: 50 years ± 18.9) presenting with symptomatic low back pain with isthmic spondylolisthesis refractory to medical management were treated by means of trans-isthmic pars interarticularis percutaneous screw fixation. Read More

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Telemedicine follow-up is safe and efficacious for synthetic midurethral slings: a randomized, multi-institutional control trial.

Int Urogynecol J 2021 Apr 20. Epub 2021 Apr 20.

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.

Introduction And Hypothesis: The objective was to assess whether telemedicine-based follow-up is equivalent to office-based follow-up in the early postoperative period after routine synthetic midurethral sling placement.

Methods: This is a prospective, international, multi-institutional, randomized controlled trial. Patients undergoing synthetic midurethral sling placement were randomized to 3-week postoperative telemedicine versus office-based follow-up. Read More

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Platelet Deficiency Represents a Modifiable Risk Factor for Periprosthetic Joint Infection in a Preclinical Mouse Model.

J Bone Joint Surg Am 2021 Mar 11. Epub 2021 Mar 11.

Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, California.

Background: Well known for their hemostatic function, platelets are increasingly becoming recognized as important immunomodulators. The purpose of the present study was to assess the impact of platelet depletion on antimicrobial host defense in a mouse model of periprosthetic joint infection (PJI).

Methods: Thrombocytopenia (TCP) was induced in C57BL/6 mice with use of a selective antibody against platelet CD41 (anti-CD41). Read More

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Incidence and Causes of Late Hospital Readmissions After Living Donor Renal Transplant: A Retrospective Study.

Exp Clin Transplant 2021 Apr 16. Epub 2021 Apr 16.

From the Department of Urology and Renal Transplant, Institute of Liver and Biliary Sciences, New Delhi, India.

Objectives: Our primary aim was to find the incidence, causes, and factors responsible for late hospital readmissions.

Materials And Methods: There were 185 patients included in the study. The patients were divided into 2 groups: those with late readmission after discharge and those with no late readmission. Read More

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Levosimendan for Treatment of Primary Graft Dysfunction After Heart Transplantation: Optimal Timing of Application.

Exp Clin Transplant 2021 Apr 16. Epub 2021 Apr 16.

From the Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.

Objectives: Primary graft dysfunction remains a serious problem after heart transplant. Pharmacological treatment with the calcium sensitizer levosimendan may be an additive treatment for primary graft dysfunction.

Materials And Methods: Patients undergoing heart transplant between 2010 and 2020 were retro - spectively reviewed and divided depending on postoperative treatment with (n = 41) or without (n = 109) levosimendan. Read More

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Perioperative management after elective cardiac surgery: the predictive value of procalcitonin for infective and noninfective complications.

Future Cardiol 2021 Apr 20. Epub 2021 Apr 20.

Geriatrics, Università Campus Bio-Medico di Roma, Rome 00128, Italy.

Procalcitonin (PCT) has been associated with adverse outcomes after cardiac surgery. Nevertheless, there is no consensus on thresholds and timing of PCT measurement to predict adverse outcomes. A total of 960 patients undergoing elective cardiac surgery were retrospectively evaluated. Read More

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Quantity and Quality of Skeletal Muscle as an Important Predictor of Clinical Outcomes in Patients with Esophageal Cancer Undergoing Esophagectomy after Neoadjuvant Chemotherapy.

Ann Surg Oncol 2021 Apr 19. Epub 2021 Apr 19.

Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.

Background: Sarcopenia was previously linked to clinical outcomes for several cancer types, including esophageal cancer (EC), but most studies only measured the quantity of skeletal muscle mass. We aim to assess the clinical significance of evaluating the quantity and quality of skeletal muscle in patients with EC who underwent neoadjuvant chemotherapy (NAC) followed by esophagectomy.

Methods: We included 333 consecutive patients with EC who underwent NAC followed by esophagectomy. Read More

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A volumetric prediction model for postoperative cyst shrinkage.

Clin Oral Investig 2021 Apr 20. Epub 2021 Apr 20.

Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria.

Objectives: With only limited information available on dimensional changes after jaw cyst surgery, postoperative cyst shrinkage remains largely unpredictable. We aimed to propose a model for volumetric shrinkage based on time elapsed since cyst surgery.

Material And Methods: We used data from patients that underwent cyst enucleation or decompression between 2007 and 2017 and had at least three computed tomography (CT) scans per patient. Read More

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Crohn's disease: a population-based study of surgery in the age of biological therapy.

Int J Colorectal Dis 2021 Apr 19. Epub 2021 Apr 19.

Klinikum rechts der Isar, School of Medicine, Department of Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.

Purpose: Despite primary conservative therapy for Crohn's disease, a considerable proportion of patients ultimately needs to undergo surgery. Presumably, due to the increased use of biologics, the number of surgeries might have decreased. This study aimed to delineate current case numbers and trends in surgery in the era of biological therapy for Crohn's disease. Read More

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Balancing Nipple and Inframammary Fold in Transaxillary Augmentation Mammaplasty with Anatomical Implant: The 'NIMF' Classification and Surgical Algorithm.

Aesthetic Plast Surg 2021 Apr 19. Epub 2021 Apr 19.

Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.33 Badachu Road, Shijingshan District, Beijing, 100144, China.

Background: This study aims to put forward a new classification of breast asymmetry based on the relative position of the nipple and inframammary fold (IMF) and propose a surgical algorithm of determining new IMF to address breast asymmetry in patients undergoing transaxillary augmentation mammaplasty, which is named as NIMF (nipple inframammary) classification and surgical algorithm.

Methods: Three hundred and forty-five patients received transaxillary augmentation mammaplasty with anatomical implants. Preoperative breast asymmetry was classified into four types. Read More

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Surgeons preference for lumbar disk surgery: a discrete choice experiment.

Eur Spine J 2021 Apr 19. Epub 2021 Apr 19.

Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands.

Purpose: Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment. Read More

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Comparison of correcting myopia and astigmatism with SMILE or FS-LASIK and postoperative higher-order aberrations.

Int J Ophthalmol 2021 18;14(4):523-528. Epub 2021 Apr 18.

Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China.

Aim: To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction (SMILE) and femtosecond laser-assisted keratomileusis (FS-LASIK).

Methods: A prospective and non-randomized controlled study was conducted. The subjects are divided into two groups according to different operations received: 229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group. Read More

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Trabeculectomy with Ologen implant versus perfluoropropane gas bubble for open angle glaucoma in pseudophakic eyes.

Int J Ophthalmol 2021 18;14(4):510-516. Epub 2021 Apr 18.

Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.

Aim: To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma.

Methods: This is a comparative randomized study included 57 pseudophakic eyes of 57 patients with medically uncontrolled open angle glaucoma (OAG). Twenty-nine patients were allocated in group I (trabeculectomy with Ologen; trab-ologen group), while 28 patients were assigned in group II (trabeculectomy with perfluoropropane gas bubble; trab-C3F8 gas bubble group). Read More

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Prevention of postoperative delirium through the avoidance of potentially inappropriate medications in a geriatric surgical patient.

BMJ Case Rep 2021 Apr 19;14(4). Epub 2021 Apr 19.

Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.

We demonstrate the utility of risk stratification for postoperative delirium in geriatric patients and show that postoperative delirium can be prevented in high-risk patients when potentially inappropriate medications (PIMs) (medications that are best avoided in older adults) are avoided. In this case, a 65-year-old woman underwent two debridement procedures with similar presurgical risk for postoperative delirium. There was no risk stratification or preoperative cognitive assessment in the first procedure, she received PIMs and developed postoperative delirium. Read More

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