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[PMID]:28746714
[Au] Autor:Cerullo M; Chen SY; Dillhoff M; Schmidt C; Canner JK; Pawlik TM
[Ad] Endereço:Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
[Ti] Título:Association of Hospital Market Concentration With Costs of Complex Hepatopancreaticobiliary Surgery.
[So] Source:JAMA Surg;152(9):e172158, 2017 Sep 20.
[Is] ISSN:2168-6262
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Trade-offs involved with market competition, overall costs to payers and consumers, and quality of care have not been well defined. Less competition within any given market may enable provider-driven increases in charges. Objective: To examine the association between regional hospital market concentration and hospital charges for hepatopancreaticobiliary surgical procedures. Design, Setting, and Participants: This study included all patients undergoing hepatic or pancreatic resection in the Nationwide Inpatient Sample from January 1, 2003, through December 31, 2011. Hospital market concentration was assessed using a variable-radius Herfindahl-Hirschman Index (HHI) in the 2003, 2006, and 2009 Hospital Market Structure files. Data were analyzed from November 19, 2016, through March 2, 2017. Interventions: Hepatic or pancreatic resection. Main Outcomes and Measures: Multivariable mixed-effects log-linear models were constructed to determine the association between HHI and total costs and charges for hepatic or pancreatic resection. Results: Weighted totals of 38 711 patients undergoing pancreatic resection (50.8% men and 49.2% women; median age, 65 years [interquartile range, 55-73 years]) and 52 284 patients undergoing hepatic resection (46.8% men and 53.2% women; median age, 59 years [interquartile range, 49-69 years]) were identified. Higher institutional volume was associated with lower cost of pancreatic resection (-5.4%; 95% CI, -10.0% to -0.5%; P = .03) and higher cost of hepatic resection (13.4%; 95% CI, 8.2% to 18.8%; P < .001). For pancreatic resections, costs were 5.5% higher (95% CI, 0.1% to 11.1%; P = .047) in unconcentrated hospital markets relative to moderately concentrated markets, although overall charges were 8.3% lower (95% CI, -14.0% to -2.3%; P = .008) in highly concentrated markets. For hepatic resections, hospitals in highly concentrated markets had 8.4% lower costs (95% CI, -13.0% to -3.6%; P = .001) compared with those in unconcentrated markets and charges that were 13.4% lower (95% CI, -19.3% to -7.1%; P < .001) compared with moderately concentrated markets and 10.5% lower (95% CI, -16.2% to -4.4%; P = .001) compared with unconcentrated markets. Conclusions and Relevance: Higher market concentration was associated with lower overall charges and lower costs of pancreatic and hepatic surgery. For complex, highly specialized procedures, hospital market consolidation may represent the best value proposition: better quality of care with lower costs.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório/economia
Preços Hospitalares/estatística & dados numéricos
[Mh] Termos MeSH secundário: Competição Econômica
Hepatectomia/economia
Seres Humanos
Pancreatectomia/economia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1001/jamasurg.2017.2158


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[PMID]:29489656
[Au] Autor:Shang Q; Geng Q; Zhang X; Xu H; Guo C
[Ad] Endereço:Department of Pathology, Linyi People's Hospital, Linyi, Shandong province.
[Ti] Título:The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis.
[So] Source:Medicine (Baltimore);97(9):e0045, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study was conducted to assess the clinical advantages of early enteral nutrition (EEN) in pediatric patients who underwent surgery with gastrointestinal (GI) anastomosis.EEN has been associated with clinical benefits in various aspect of surgical intervention, including GI function recovery and postoperative complications reduction. Evaluable data documenting clinical advantages with EEN for pediatric patients after surgery with GI anastomosis are limited.We retrospectively reviewed the medical records of 575 pediatric patients undergoing surgical intervention with GI anastomosis. Among them, 278 cases were managed with EEN and the remaining cases were set as late enteral nutrition (LEN) group. Propensity score (PS) matching was conducted to adjust biases in patient selection. Enteral feeding related complications were evaluated with symptoms, including serum electrolyte abnormalities, abdominal distention, abdominal cramps, and diarrhea. Clinical outcomes, including GI function recovery, postoperative complications, length of hospital stay, and postoperative follow-up, were assessed according to EEN or LEN.Following PS matching, the baseline variables of the 2 groups were more comparable. There were no differences in the incidence of enteral feeding-related complications. EEN was associated with postoperative GI function recovery, including time to first defecation (3.1 ±â€Š1.4 days for EEN vs 3.8 ±â€Š1.0 days for LEN, risk ratio [RR], 0.62; 95% confidence interval [CI] 0.43-1.08, P = .042). A lower total episodes of complication, including infectious complications and major complications were noted in patients with EEN than in patients with LEN (117 [45.9%] vs 137 [53.7%]; OR, 0.73, 95% CI 0.52-1.03, P = .046). Mean postoperative length of stay in the EEN group was 7.4 ±â€Š1.8 days versus 9.2 ±â€Š1.4 days in the LEN group (P = .007). Furthermore, the incidence of adhesive small bowel obstruction was lower for patients with laxative administration compared with control, but no significant difference was attained (P = .092)EEN was safe and associated with clinical benefits, including shorten hospital stay, and reduced overall postoperative complications on pediatric patients undergoing GI anastomosis.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório
Nutrição Enteral
Cuidados Pós-Operatórios
[Mh] Termos MeSH secundário: Anastomose Cirúrgica/efeitos adversos
Pré-Escolar
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Nutrição Enteral/efeitos adversos
Feminino
Seguimentos
Seres Humanos
Perfuração Intestinal/cirurgia
Intestinos/cirurgia
Tempo de Internação
Masculino
Cuidados Pós-Operatórios/efeitos adversos
Complicações Pós-Operatórias
Pontuação de Propensão
Recidiva
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010045


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[PMID]:29428021
[Au] Autor:Martinez JL; Luque-de-León E; Souza-Gallardo LM; Jiménez-López M; Ferat-Osorio E
[Ti] Título:Results after Definitive Surgical Treatment in Patients with Enteroatmospheric Fistula.
[So] Source:Am Surg;84(1):28-35, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:As enteroatmospheric fistulas (EAF) lack healthy overlying tissue, spontaneous healing is very unlikely. Our aim was to identify risk factors for recurrence and mortality after definitive surgical treatment for EAF. Sixty-two consecutive patients with a diagnosis of EAF were submitted to definitive surgical repair (fistula resection and primary anastomosis) during a 6-year period. Several patient, disease, and operative variables were assessed as risk factors associated to our endpoints: recurrence and mortality. All patients were followed-up until hospital discharge or death. Univariate and multivariate analysis were performed. There were 24 females and 38 males with a median age of 53 years (interquartile ranges 43-63). EAF recurred in 23 patients. Univariate analysis identified several risk factors for recurrence which included performing more than one anastomosis (20 vs 52%, P = 0.013), failure of achieving total abdominal closure (16 vs 47%, P = 0.025), intraoperative hemorrhage >400 cc (28 vs 65%, P = 0.007), presence of multiple fistulas (25 vs 61%, P = 0.008), and preoperative C-reactive protein >0.5 mg/dL (54 vs 82%, P = 0.029). The latter two remained significant after multivariate analysis. Final EAF closure was attained in 47 patients (76%) and 8 more (13%) had a low-output (<50 mL/day) enterocutaneous fistula. Timing of surgery was not related to fistula recurrence. Eight patients died (13%), and fistula recurrence was the only risk factor found related to mortality both through univariate (26 vs 5%, P = 0.043) and after multivariate analysis. EAF management represents a rather challenging problem. Timing for surgical treatment is controversial and is based mostly on patient status and surgeon's criteria. Recurrence is associated to EAF characteristics and an inflammatory state; it was also the only factor associated to mortality.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório
Fístula Intestinal/diagnóstico
Fístula Intestinal/cirurgia
[Mh] Termos MeSH secundário: Adulto
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Procedimentos Cirúrgicos do Sistema Digestório/mortalidade
Feminino
Seguimentos
Seres Humanos
Fístula Intestinal/etiologia
Fístula Intestinal/terapia
Masculino
Meia-Idade
Estudos Prospectivos
Recidiva
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Cicatrização
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29443751
[Au] Autor:Zhang K; Qu S; Li J; Cheng Y; Shi J; Liu T
[Ad] Endereço:Department of General Surgery.
[Ti] Título:A case report of rectal schwannoma treated with laparoscopic proctectomy.
[So] Source:Medicine (Baltimore);97(7):e9866, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Schwannomas of gastrointestinal tracts are rare and difficult to detect preoperatively because of negative results of endoscopic and imaging examinations. Here, we reported a case of rectal schwannoma, which was diagnosed by immunohistochemical staining after laparoscopic protectomy. PATIENT CONCERNS: A 61-year-old woman complained of a 1-month history of difficulty in defecation and irregularly abdominal discomfort during her physical checkup in our hospital. DIAGNOSES: Immunohistochemical staining results after laparoscopic protectomy revealed a strong positive reaction for S-100 protein. Therefore, rectal schwannoma was confirmed. INTERVENTIONS: Treatment with laparoscopic protectomy was given. OUTCOMES: Symptoms resolved completely after 12 days of the surgery, and was regular followed-up in outpatient clinic. LESSONS: Schwannomas are difficult to identify preoperatively, and immunohistochemical staining for S-100 protein is an effective method to diagnose it.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório/métodos
Laparoscopia/métodos
Neurilemoma
Neoplasias Retais
Proteínas S100/análise
[Mh] Termos MeSH secundário: Biópsia/métodos
Feminino
Seres Humanos
Imuno-Histoquímica
Meia-Idade
Neurilemoma/patologia
Neurilemoma/fisiopatologia
Neurilemoma/cirurgia
Neoplasias Retais/patologia
Neoplasias Retais/fisiopatologia
Neoplasias Retais/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (S100 Proteins)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009866


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[PMID]:29327910
[Ti] Título:Local recurrence in patients treated for rectal cancer using total mesorectal excision or transection of mesorectum.
[So] Source:Vojnosanit Pregl;73(10):927-33, 2016 Oct.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Background/Aim: Rectal cancer is a major health problem throughout the world, despite the great progress in the treatment and control of the disease. The aim of this study was to determine the effect of mesorectal excision type on local recurrence in patients operated on for rectal cancer within a 3- year period. Methods: The clinical retrospective study was conducted at the Clinic for General Surgery at the Clinical Center in Nis, Serbia, and included 225 patients with rectal cancer. Postoperatively, the patients were observed 36 months. Total mesorectal excision (TME) method was used in 129 (57.33%) patients, and partial mesorectal excision (PME) in 96 (42.66%). There were 145 (64.44%) man and 80 (35.55%) women, average age 66.8 years. Results: In 58 (25.77%) of the patients cancer was localized in the proximal third of the rectum, in 99 (44%) in the medium third, in 68 (30.22%) it was 8 cm of the anocutaneous line. In 167 (74.22%) patients rectal cancer was in T3 stadium. TME was performed in all the patients with cancer in the distal third of the rectum and in 61.61% of the patients with cancer in the medium third of the rectum. PME was performed in all the patients with localized cancer in the proximal third and in 38.38% of the patients with cancer in the medium third of the rectum. Local recurrence occurred in 20 (8.88%) patients, 12 (9.30%) in the TME group and 8 (8.33%) in the PME group, which was not a statistically significant difference. In 75% of the cases, relapse occurred in the patients in T3 stage. Relapse occurred in 55% of the cases in the second year after the surgery. The median survival of all the patients amounted to 35 months. The total mortality of all respondents in a 3-year period amounted to 5.3%. Conclusion: There were no statistically significant differences in the incidence of local recurrence and survival among patients who underwent TME and those underwent PME. The type of mesorectal excision does not affect the incidence of local recurrence in node-negative disease stages.
[Mh] Termos MeSH primário: Adenocarcinoma/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Recidiva Local de Neoplasia
Neoplasias Retais/cirurgia
[Mh] Termos MeSH secundário: Adenocarcinoma/mortalidade
Adenocarcinoma/patologia
Idoso
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Procedimentos Cirúrgicos do Sistema Digestório/mortalidade
Intervalo Livre de Doença
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Estadiamento de Neoplasias
Modelos de Riscos Proporcionais
Neoplasias Retais/mortalidade
Neoplasias Retais/patologia
Estudos Retrospectivos
Fatores de Risco
Sérvia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180113
[St] Status:MEDLINE
[do] DOI:10.2298/VSP150430092M


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[PMID]:29384902
[Au] Autor:Zhang Y; Wang D; Zhu L; Wang B; Ma X; Shi B; Yan Y; Zhou C
[Ad] Endereço:Department of the Second Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University.
[Ti] Título:Standard versus extralevator abdominoperineal excision and oncologic outcomes for patients with distal rectal cancer: A meta-analysis.
[So] Source:Medicine (Baltimore);96(52):e9150, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The role of extralevator abdominoperineal excision (ELAPE) for distal rectal cancer remains controversial, and the procedure is not widely accepted or practiced. METHODS: An electronic search of Medline, EMBASE, Web of Science, and similar databases for articles in English was performed from the inception of the study until October 31, 2017. Two reviewers extracted information and independently assessed the quality of included studies by the methodological index for nonrandomized studies, then data were analyzed with Review Manager 5.3 software and Stata version 12.0 software. RESULTS: Our meta-analysis included 17 studies with 3479 patients, of whom 1915 (55.0%) underwent ELAPE and 1564 (44.0%) underwent abdominoperineal excision (APE). Compared with patients undergoing APE, patients undergoing ELAPE had a significant reduced risk of no more than 3 years local recurrence (LR) (risk ratio [RR] = 0.27, 95% confidence interval [CI] = 0.08-0.94), 3-year mortality (odds ratio [OR] = 0.45, 95% CI = 0.20-0.97), intraoperative bowel perforation (IBP) involvement (RR = 0.48, 95% CI = 0.31-0.74), and circumferential resection margin (CRM) positivity (RR = 0.66, 95% CI = 0.43-1.00) at the threshold level. CONCLUSIONS: The application of ELAPE is more effective in reducing the chance of 3 years LR, mortality, IBP involvement and CRM positivity than conventional APE, and worthy of being widely applied in surgical treatment of the distal rectal cancer.
[Mh] Termos MeSH primário: Neoplasias Retais/cirurgia
[Mh] Termos MeSH secundário: Procedimentos Cirúrgicos do Sistema Digestório
Seres Humanos
Neoplasias Retais/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009150


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[PMID]:29381999
[Au] Autor:Zhu Y; Jiang H; Chen Z; Lu B; Wu J
[Ti] Título:Abdominal surgery in patients with essential thrombocythemia: A case report and systematic review of literature.
[So] Source:Medicine (Baltimore);96(47):e8856, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Essential thrombocythemia/thrombocytosis (ET) is characterized by increased bleeding and thrombosis risk during the perioperative period. We report the case of a woman with ET and sigmoid colon cancer, in whom the postoperative course was complicated by anastomotic bleeding. A systematic review was conducted to seek guidance for the management of such patient in the perioperative period. METHODS: A systematic literature review was conducted using EMBASE, Medline, and PubMed databases to detect relevant English language articles. Published studies with full-text articles were included. Two authors independently searched and extracted the data. Any differences were resolved by consensus. Studies on abdominal surgery were manually retrieved. RESULTS: Four case reports (including our case report) that described abdominal surgery in patients with ET were included. All patients were females, with a mean age of 47 years. Laparoscopic surgery was performed in 2 patients, and open surgery was performed in the other 2 patients. Two patients had postoperative bleeding that occurred on the first postoperative day. There was one case of pseudohyperkalemia after surgery and one case of Budd-Chiari syndrome caused by hepatic vein thrombosis. No guidelines for patients with ET undergoing abdominal surgery were found. CONCLUSION: In conclusion, there are currently no definitive guidelines for the perioperative management of patients with ET. Furthermore, there are few reports of ET in patients with malignancy undergoing surgery. Further studies in this unique group of patients are required.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/efeitos adversos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Hemorragia Pós-Operatória/etiologia
Neoplasias do Colo Sigmoide/cirurgia
Trombocitemia Essencial/cirurgia
[Mh] Termos MeSH secundário: Abdome/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Feminino
Seres Humanos
Meia-Idade
Trombocitemia Essencial/complicações
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008856


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[PMID]:29181995
[Au] Autor:Moosvi SR; Manley K; Hernon J
[Ad] Endereço:Norfolk and Norwich University Hospitals NHS Foundation Trust , UK.
[Ti] Título:The effect of rectal washout on local recurrence following rectal cancer surgery.
[So] Source:Ann R Coll Surg Engl;100(2):146-151, 2018 Feb.
[Is] ISSN:1478-7083
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Introduction Local recurrence after surgery for rectal cancer is associated with significant morbidity and debilitating symptoms. Intraoperative rectal washout has been linked to a reduction in local recurrence but there is no conclusive evidence. The aim of this study was to evaluate whether performing rectal washout had any effect on the incidence of local recurrence in patients undergoing anterior resection for rectal cancer in the context of the current surgical management. Methods A total of 395 consecutive patients who underwent anterior resection with or without rectal washout for rectal cancer between January 2003 and July 2009 at a high volume single institution were analysed retrospectively. A standardised process for performing washout was used and all patients had standardised surgery in the form of total mesorectal excision. Neoadjuvant and adjuvant therapy was used on a selected basis. Patients were followed up for five years and local recurrence rates were compared in the two groups. Results Of the 395 patients, 297 had rectal washout and 98 did not. Both groups were well matched with regard to various important clinical, operative and histopathological characteristics. Overall, the local recurrence rate was 5.3%. There was no significant difference in the incidence of local recurrence between the washout group (5.7%) and the no washout group (4.1%). Conclusions Among our cohort of patients, there was no statistical difference in the incidence of local recurrence after anterior resection with or without rectal washout. This suggests that other factors are more significant in the development of local recurrence.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório
Recidiva Local de Neoplasia
Neoplasias Retais
Irrigação Terapêutica
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Recidiva Local de Neoplasia/epidemiologia
Recidiva Local de Neoplasia/patologia
Recidiva Local de Neoplasia/cirurgia
Neoplasias Retais/epidemiologia
Neoplasias Retais/patologia
Neoplasias Retais/cirurgia
Estudos Retrospectivos
Irrigação Terapêutica/efeitos adversos
Irrigação Terapêutica/métodos
Irrigação Terapêutica/estatística & dados numéricos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1308/rcsann.2017.0202


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[PMID]:29369192
[Au] Autor:Chen H; Siwo EA; Khu M; Tian Y
[Ad] Endereço:Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
[Ti] Título:Current trends in the management of Mirizzi Syndrome: A review of literature.
[So] Source:Medicine (Baltimore);97(4):e9691, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Mirizzi Syndrome is a rare and challenging clinical entity to manage. However, recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition. This paper reviews these new diagnostic modalities and treatment approaches for the management of Mirizzi Syndrome.An online search language was performed using PubMed and Web of Science for literature published in English between 2012 and 2017 using the search terms "Mirizzi Syndrome" and "Mirizzi." In total, 16 case series and 11 case reports were identified and analyzed.The most frequently used diagnostic modalities were ultrasound, computed tomography (CT); magnetic resonance cholangiopancreaticography (MRCP); endoscopic retrograde cholangiopancreaticography (ERCP). A combination of ≥2 diagnostic modalities was frequently used to detect Mirizzi Syndrome. Literature shows that the specific type of Mirizzi Syndrome determined the type of treatment chosen. Open surgery was the preferred option, although there are documented cases of the use of minimally-invasive techniques, even in advanced cases. Laparoscopic, endoscopic or robot-assisted surgery, used individually or in combination with lithotripsy, were all associated with a favorable outcome.As yet, there are no internationally-accepted guidelines for the management of Mirizzi Syndrome. Laparotomy is the preferred surgical technique of choice, although an increasing number of surgeons are beginning to opt for minimally-invasive techniques. The number of papers in the existing literature describing diagnostic and treatment procedures is relatively small at present, thus making it difficult to reasonably propose an evidence-based standard of care for Mirizzi Syndrome.
[Mh] Termos MeSH primário: Técnicas de Diagnóstico do Sistema Digestório/tendências
Procedimentos Cirúrgicos do Sistema Digestório/tendências
Gerenciamento Clínico
Síndrome de Mirizzi/diagnóstico
Síndrome de Mirizzi/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009691


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[PMID]:28468890
[Au] Autor:Yeung SE; Hilkewich L; Gillis C; Heine JA; Fenton TR
[Ad] Endereço:Nutrition Services and sophia.yeung@ahs.ca.
[Ti] Título:Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery.
[So] Source:Am J Clin Nutr;106(1):44-51, 2017 Jul.
[Is] ISSN:1938-3207
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. We conducted a prospective cohort study in adult elective colorectal resection patients after conventional ( = 46) and ERAS ( = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg · d ; ERAS group: 0.54 g · kg · d ; < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables ( = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS ( = 0.049) and fewer total infectious complications ( = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; < 0.001), and the consumption of ≥60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: -6.8, -2.0 d; < 0.001). ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS. This trial was registered at clinicaltrials.gov as NCT02940665.
[Mh] Termos MeSH primário: Neoplasias Colorretais/cirurgia
Proteínas na Dieta/administração & dosagem
Suplementos Nutricionais
Procedimentos Cirúrgicos do Sistema Digestório
Tempo de Internação
Estado Nutricional
Cuidados Pós-Operatórios/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Cirurgia Colorretal
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Ingestão de Energia
Comportamento Alimentar
Seres Humanos
Intestino Grosso/cirurgia
Masculino
Meia-Idade
Náusea/etiologia
Necessidades Nutricionais
Assistência Perioperatória
Complicações Pós-Operatórias
Estudos Prospectivos
Padrão de Cuidado
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Dietary Proteins)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180121
[Lr] Data última revisão:
180121
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.3945/ajcn.116.148619



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