bluuebunny/crossref_metadata_2025 huggingface dataset:
Allergic Reactions Captured by Voluntary Reporting
Authors: Blumenthal Kimberly G. , Wolfson Anna R. , Li Yu , Seguin Claire M. , Phadke Neelam A. , Banerji Aleena , Mort Elizabeth
Published: February 2019

Background

The epidemiology of hospital adverse reactions (ARs), particularly allergic reactions, or hypersensitivity reactions (HSRs), is poorly defined. To determine priorities for allergy safety in healthcare, we identified and described safety reports of allergic reactions.

Methods

We searched the safety report database of a large academic medical center from April 2006 to March 2016 using 101 complete, truncated, and/or misspelled key words related to allergic symptoms, treatments, and culprits (e.g., medications, foods). Patient and event data were summarized for ARs and two types of ARs, HSRs and side effects/toxicities.

Results

Among 9111 key word search–identified events, 876 (10%) were ARs, of which 436 (5%) were HSRs and the remaining 440 (5%) were side effect reactions or toxicities. Whereas the most common HSRs were simple cutaneous reactions (83%), the following severe immediate HSRs were also identified: shortness of breath (16%), anaphylaxis (14%), and angioedema (12%). Most HSRs were caused by drugs (81%), with antibiotics (26%), particularly β-lactams (11%), and vancomycin (8%), commonly implicated. Other causes of drug HSRs included contrast agents (24%), chemotherapeutics (7%), and opioids (6%). Nondrug HSRs were from blood products (8%), latex (3%), and devices (3%). Food reactions were rarely identified (1%).

Conclusions

We identified ARs, HSRs, and side effects/toxicities, contained in a decade of safety reports at an academic medical center. Allergy safety in the healthcare setting should target approaches to common and severe reactions, with a focus on the safe administration of β-lactams, vancomycin, contrast agents, chemotherapeutics, and opioids. Priority nondrug HSR culprits include blood products, latex, and devices.
Supplying Pharmacist Home Visit and Anticoagulation Professional Consultation During Transition of Care for Patients With Venous Thromboembolism
Authors: Kapoor Alok , Landyn Valentina , Wagner Joann , Burgwinkle Pamela , Huang Wei , Gore Joel , Spencer Frederick A. , Goldberg Robert , McManus David D. , Darling Chad , Boudreaux Edwin , Barton Bruce , Mazor Kathleen M.
Published: February 2019

Objective

The aim of the study was to assess the feasibility, satisfaction, and effectiveness of a care transition intervention with pharmacist home visit and subsequent anticoagulation expert consultation for patients with new episode of venous thromboembolism within a not-for-profit health care network.

Methods

We randomized patients to the intervention or control. During the home visit, a clinical pharmacist assessed medication management proficiency, asked open-ended questions to discuss knowledge gaps, and distributed illustrated medication instructions. Subsequent consultation with anticoagulation expert further filled knowledge gaps. At 30 days, we assessed satisfaction with the intervention and also measured the quality of care transition, knowledge of anticoagulation and venous thromboembolism, and anticoagulant beliefs (level of agreement that anticoagulant is beneficial, is worrisome, and is confusing/difficult to take).

Results

The mean ± SD time required to conduct home visits was 52.4 ± 20.5 minutes and most patients agreed that the intervention was helpful. In general, patients reported a high-quality care transition including having been advised of safety issues related to medications. Despite that, the mean percentage of knowledge items answered correctly among patients was low (51.5 versus 50.7 for intervention and controls, respectively). We did not find any significant difference between intervention and control patients for care transition quality, knowledge, or anticoagulant beliefs.

Conclusions

We executed a multicomponent intervention that was feasible and rated highly. Nevertheless, the intervention did not improve care transition quality, knowledge, or beliefs. Future research should examine whether alternate strategies potentially including some but not all components of our intervention would be more impactful.
Outcomes of Pregnancy in Women With Inflammatory Myositis
Authors: Gupta Latika , Zanwar Abhishek , Ahmed Sakir , Aggarwal Amita
Published: February 2019

Objectives

Idiopathic inflammatory myositis (IIM) commonly affects women in the childbearing age group. Both disease activity and immunosuppressants used may have adverse effects on fertility and outcomes of pregnancy. We explored these outcomes in a cohort of women with IIM.

Methods

Women 18 years or older with IIM (Bohan and Peter criteria) were interviewed for demography, menstrual status, history of conception, outcomes, and disease features. Comparisons were drawn between pregnancies occurring before and after onset of disease.

Results

Eighty-one IIM patients with median age of 32 years (interquartile range, 26–50 years) and disease duration of 4 years (interquartile range, 2–9 years) were interviewed. Forty-five patients had dermatomyositis, 20 had polymyositis, and 16 had overlap myositis. Sixty-three patients had conceived before disease onset, resulting in 205 pregnancies and 155 live births over 315.2 patient-years of follow-up.

After disease onset, there were 24 pregnancies (6 live births, 16 spontaneous abortions, and 2 induced abortions) in 7 women over 77.5 patient-years. Of the live births, 1 had cleft palate, 1 had low birth weight, and 1 was preterm. None of the patients who conceived had antiphospholipid antibodies.

Obstetric complications (relative risk [RR] = 7.6; p < 0.0001) and fetal complications (RR = 2.7; p = 0.002) occurred more frequently in pregnancies after the onset of myositis, although there was no difference in maternal complications. Conception after the onset of myositis had higher risk of abortion (RR = 3.6; p < 0.0001).

Conclusions

Women with IIM suffer from poor fetal outcomes as well as high rates of spontaneous abortion rates in the absence of clinical or serologic anti-phospholipid syndrome.
A Randomized Internet-Based Pilot Feasibility and Planning Study of Cherry Extract and Diet Modification in Gout
Authors: Singh Jasvinder A. , Green Candace , Morgan Sarah , Willig Amanda L. , Darnell Betty , Saag Kenneth G. , Weiss Rick , Cutter Gary , McGwin Gerald
Published: February 2019

Objective

The aim of this study was to conduct a 9-month pilot Internet randomized controlled trial (RCT) of cherry extract and diet modification in gout to assess the feasibility of an Internet study and obtain effect estimates.

Methods

After providing online informed consent in response to Internet advertisements and social media or clinic flyers, 84 people with physician-confirmed gout were randomized to either cherry extract 3,600 mg/d (n = 41) or dietitian-assisted diet modification for gout (n = 43). All study outcomes were collected via Internet and phone calls. The primary objective was the feasibility of an Internet study, and secondary objectives were to obtain effect estimates for gout flares, functional ability assessed with the Health Assessment Questionnaire (HAQ), and adverse events (AEs) for future trials.

Results

Of the 84 people randomized, overall completion rates were more than 80% for most study procedures up to 6 months and similar for the 2 active comparators. Improvements were seen in gout flares and HAQ scores in cherry extract and diet modification groups at 9 months compared with baseline: gout flares per month, 0.22 versus 0.36 (p = 0.049) and 0.28 versus 0.31 (p = 0.76); proportion with any gout flare, 56% versus 98% (p < 0.0001) and 65% versus 98% (p = 0.0002); and mean ± standard deviation HAQ score, 0.28 ± 0.54 versus 0.55 ± 0.68 (p = 0.001) and 0.23 ± 0.40 versus 0.48 ± 0.61 (p = 0.06), respectively. Any AEs and gastrointestinal symptoms/AEs at 9 months in cherry extract and diet modification groups were 3% versus 0% and 28% versus 27%, respectively.

Conclusions

An Internet gout RCT is feasible for nonpharmacological gout treatments. A hypothesis-testing, large Internet RCT of cherry extract versus placebo is needed.
A Novel Method for Segmentation-Based Semiautomatic Quantitative Evaluation of Metal Artifact Reduction Algorithms
Authors: Do Thuy D. , Sommer Christof M. , Melzig Claudius , Nattenmüller Johanna , Vollherbst Dominik , Kauczor Hans-Ulrich , Stiller Wolfram , Skornitzke Stephan
Published: February 2019

Objectives

The aim of this study was to establish an objective segmentation-based evaluation of metal artifact reduction algorithms in the context of percutaneous microwave ablation in a porcine model.

Materials and Methods

Five computed tomography acquisitions from a previous animal study on computed tomography–guided percutaneous applicator positioning for microwave antenna were reconstructed with 6 different algorithms (30 image series total): standard filtered backprojection (B30f) and iterative reconstruction (ADMIRE-I30–1, ADMIRE-I30–3), all with and without metal artifact reduction. For artifact quantification, 3-dimensional segmentation of liver parenchyma without visible artifacts (VLiverReference) and liver volume surrounding the antenna (VLiverVOI) was performed, determining thresholds for artifact segmentation and calculating volume of voxels influenced by artifacts. Objective image analysis was based on relative volume of artifacts, and subjective image quality (ie, metal artifact extent) was evaluated by 2 independent observers. Correlation between objective and subjective evaluation was calculated.

Results

Both objective and subjective evaluations showed a significant reduction in metal artifacts when using dedicated metal artifact reduction algorithms (both P < 0.05). No significant reduction in metal artifacts was found when using iterative reconstruction (both P > 0.05). A good correlation between subjective and objective image quality was found (Spearman rank correlation coefficient r
s = 0.65; P < 0.05). Interreader agreement was substantial (κ = 0.67).

Conclusions

Segmentation-based objective evaluation of metal artifacts shows good agreement with conventional subjective evaluations and offers a promising quantitative and precise approach with limited time expenditure.
Baseline Pancreatic Beta Cell Imaging After Pancreatic Transplantation Using Whole-Body 68Ga-DOTA-Exendin-4 PET/CT
Authors: Gambhir Aashish , Jain Avani , Elangovan Indirani , Simon Shelley
Published: February 2019

Whole pancreatic transplant and islet cells transplantation are currently available strategies aiming toward diabetes cure. Beta cell specific noninvasive functional imaging using novel PET radiotracers are now available and can be used for beta cell imaging and quantification. Herein we describe a spectrum of 2 cases demonstrating beta cell targeted imaging using 68Ga-DOTA-exendin-4 PET/CT in patients with diabetes after simultaneous pancreas-kidney transplantation.
Multiple Myeloma of Testes and Spermatic Cord on 18F-FDG PET/CT
Authors: Velaga Jyothirmayi , Liang Huang Hian , Gopalakrishnan Sathish Kumar
Published: February 2019

Extramedullary multiple myeloma (EM) has negative prognostic implications on the overall survival as well as progression-free survival. Testis is a rare site of EM, which can be a part of diffuse involvement in multiple myeloma or a site of recurrence in patients with remission. We present a case of EM of testes and left spermatic cord in an 80-year-old man who presented with painless progressive enlargement of the scrotum. 18F-FDG PET/CT revealed tracer avidity of both testes and left spermatic cord. Bilateral radical orchidectomy was subsequently performed, and the diagnosis of multiple myeloma was confirmed on histopathology.
18F-FDG PET/CT in Intramuscular Mantle Cell Lymphoma With Elongated Lymphomatous Neurovascular Extension
Authors: Hod Nir , Levin Daniel , Anconina Reut , Ezroh Kazap Dina , Lantsberg Sophie
Published: February 2019

Skeletal muscle involvement by lymphoma is rare, particularly for mantle cell lymphoma. We describe a 65-year-old man who presented with a rapidly growing left thigh mass. FDG PET/CT characterized the mass as malignant. Interestingly, an unusual hypermetabolic elongated tumorous extension was demonstrated arising from the intramuscular mass disseminating alongside the neurovascular bundle of the thigh up to the groin. Histopathology revealed intramuscular mantle cell lymphoma. In this case, we aim to highlight this interesting FDG PET/CT imaging finding, which can serve as a clue allowing one to strongly suggest lymphoma as the leading diagnosis.
Pericholecystic Rim Sign and Gallbladder Nonvisualization Indicating Acute Gangrenous Cholecystitis on 99mTc-MIBI Myocardial Perfusion SPECT
Authors: Qutbi Mohsen , Ahmadi Reyhana
Published: February 2019

Rim sign is assumed as an ominous sign of gangrenous cholecystitis and mandates an urgent surgery. The main mechanism by which this phenomenon arises is increased regional blood flow as a result of an inflammatory process. Therefore, it is expected that this finding be visualized in varieties of scans with various radiopharmaceuticals, including myocardial perfusion scan with 99mTc-MIBI as an extracardiac finding. Herein, we present a case of acute cholecystitis with a rim sign on preoperative myocardial perfusion SPECT using 99mTc-MIBI, which posed the possibility of gangrene and perforation and thus the need for urgent surgical intervention.
Lymphadenopathy Due to Kimura’s Disease Mimicking Lymphoma on FDG PET/CT
Authors: Yu MingMing , Wang ZhenGuang , Zhao Jing , Wu FengYu
Published: February 2019

Kimura’s disease is a clinically rare, chronic, benign lymphoproliferative disorder of unknown etiology. A 36-year-old man presented with painless axillary swelling, which was suspected as lymphoma. PET/CT was performed for staging. The images showed multiple foci of increased activity in bilateral axillary and right inguinal lymph nodes. Laboratory tests revealed an increased eosinophil ratio and eosinophil count. Pathological examination from dissected axillary lymph nodes was consistent with Kimura’s disease.
Dynamic Renal Ptosis Demonstrated on 18F-FDG PET/CT
Authors: Taylor Justin , Prasad Kalpna , Rohrer Rebecca
Published: February 2019

Renal ptosis, otherwise known as nephroptosis or “floating kidney,” is a condition of abnormal descent of the kidney, often asymptomatic with controversy over its clinical and therapeutic significance. The aberrant location of renal and renal collecting system activity associated with this condition may serve as a diagnostic pitfall in PET/CT interpretation. We report a case of dynamic renal ptosis demonstrated on 18F-FDG PET/CT, identified as right kidney migration from an ectopic location on attenuation correction CT images, obtained immediately after upright positioning, to the right renal fossa on subsequent PET images, obtained after approximately 10 min of supine positioning.
Remarkable Response of Pulmonary Metastases Rather Than Remnant Thyroid in 131I Therapy of Follicular Thyroid Cancer
Authors: Tian Tian , Chen Yu , Xiang Yongzhao , Liu Lina , Liu Bin
Published: February 2019

A 66-year-old man with follicular thyroid cancer after total thyroidectomy was referred for 131I therapy. Thyroid function tests before 131I administration exhibited severe thyrotoxicosis although the patient did not take levothyroxine after thyroidectomy. A 185 MBq 131I whole-body scintigraphy and SPECT/CT revealed multiple iodine-avid pulmonary metastases with the largest tumor diameter of 1.4 cm and remnant thyroid. A diagnosis of thyrotoxicosis caused by hyperfunctioning pulmonary metastases was then made. The patient was administered 7.4 GBq of 131I. Six months after 131I therapy, a significant reduction of the pulmonary metastatic disease and thyroglobulin level was observed. However, the remnant thyroid was still visualized.
Similar Appearance on Dynamic Images of Meckel Scintigraphy Caused by Different Etiologies
Authors: Wen Zhe , Salerno Lorianne , Zhuang Hongming
Published: February 2019

Positive gastric mucosa Meckel diverticulum generally shows nonmoving activity in the right abdomen, which appears early in the study at about the same time of the appearance of the stomach. However, a stoma from ileostomy can result in similar findings on dynamic images. The difference between a true Meckel diverticulum and stoma can be exposed by lateral views.
Gender and Age Differences of Temporomandibular Joint Disc Perforation: A Cross-Sectional Study in a Population of Patients With Temporomandibular Disorders
Authors: Li Wei , Cheng Yong , Wei Lili , Li Bo , Zheng Hongyu
Published: February 2019

The presence or absence of disc perforation (DP) has great value for the treatment planning of temporomandibular disorders (TMDs). Epidemiologic features of DP are limited in the literature. The present study investigated the epidemiologic features of DP by retrospectively reviewing 13,556 temporomandibular joint arthrographic examinations. Pearson Chi-squared test demonstrated that the rate of male patients who received the examinations more than once was significantly lower than that of female patients and the rate of DP in males was significantly lower than that in females. The age of all patients showed a bimodal distribution, with a 1st peak around 21 years of age, and a 2nd peak around 53 years of age. Linear regression analysis showed that the rate of DP was positively correlated with ages. The DP rate was increased by 0.3% for every 1 year of age. This retrospective cross-sectional study validated some findings about the gender and age differences of temporomandibular joint DP in the literature, and more importantly uncovered the exact relationship between the DP rate and the age in a large TMD patient population.
Cranioplasty Using Polymethylmethacrylate Cement Following Retrosigmoid Craniectomy Decreases the Rate of Cerebrospinal Fluid Leak and Pseudomeningocele
Authors: Ou Changjiang , Chen Yili , Mo Jun , Wang Shenghu , Gai Shiying , Xing Ruxin , Wang Bo , Wu Chunlai
Published: February 2019

Objective:

Cerebrospinal fluid (CSF) leak frequently occurs after retrosigmoid craniectomy. The present study investigated the effects of cranioplasty using polymethylmethacrylate (PMMA) cement to reduce the incidence of CSF leak following retrosigmoid craniectomy as compared with the autologous bone flap combined with titanium plates.

Methods:

Two hundred forty-three patients underwent surgeries via retrosigmoid approach for microvascular decompression or tumor resection. Of these, 107 patients underwent craniotomy, and incomplete cranioplasty was performed with autologous bone flap fixed with titanium plates, while 136 patients underwent craniectomy and complete cranioplasty was performed with PMMA cement. Variables including the incidence of CSF leak, pseudomeningocele formation, wound infection, rejection reaction were compared retrospectively based on the clinical data between the 2 groups.

Results:

In the autologous bone group, 9 patients had postoperative CSF leaks, and 11 patients had pseudomeningoceles, while 3 CSF leaks and 2 pseudomeningoceles were found in the PMMA group. Statistical analysis showed that PMMA significantly decreased the incidence of postoperative CSF leaks (P = 0.03) and pseudomeningocele formation (P = 0.002). Wound infections were observed in 2 and 1 patients between the autologous bone and PMMA group, respectively, which did not differ significantly (P = 0.58). None of the patients in both groups developed a rejection reaction of artificial materials.

Conclusions:

Complete cranioplasty with PMMA cement following retrosigmoid craniectomy could decrease the incidence of CSF leak and pseudomeningocele formation as compared with the autologous bone flap combined with titanium plates. Thus, PMMA cement is preferable for bone reconstruction with excellent biocompatibility and without increasing the rate of wound infection.
Craniometric Analysis of Skullbase With Magnetic Resonance Imaging in Patients With Chiari Malformation
Authors: Guvenc Gonul , Sarp Ali Firat , Kizmazoglu Ceren , Uzunoglu Inan , Atar Murat , Tuna Salih , Sayin Murat , Yuceer Nurullah
Published: February 2019

Basilar invagination, Platibasi, increased tentorium angle, and posterior fossa hypoplasia are the anomalies associated with Chiari malformation. When Chiari is symptomatic; tonsillary ectopenia appears to be a definitive criterion for diagnosis and treatment, the detection of additional anomaly may alter the surgical outcome. The aim of this study is to investigate the relationship between tonsillar ectopia and other anomalies.

The authors retrospectively reviewed 31 cases which had Chiari Malformation at our Hospital. There were 8 men (25.8%) and 23 female (74.2%). Average age of the samples is 37.93 ± 12.93 years. Seventeen patients (54.8%) had tonsillar ectopia 0 to 5 mm, 14 patients had tonsillar ectopia over 5 mm. Seven patients had syrinx (22.6%), 2 patients had mild hydrocephalus (6.5%). Six patients had surgery for the treatment. The mean length of the clivus was 39.3 mm, supraoksiput length was 40.4 mm, cerebellar hemisphere length was 61.08 mm, Mc Rae line was 33.14 mm, Twinning Line was 79.4mm, and Tentorium-Twinning line angle was 40.35°. There was no significant difference between Tonsillar ectopia, syrinks, and hydrocephalus. Basilar invagination had relationship between platibasi (6 patients had platibasi according to 2 mm criteria, 2 patients had platibasi according to 5 mm criteria (P < 0.05). Patients with syrinx had relationship between Chamberlain line (P < 0.05).

In the authors’ study, although there was no statistically significant difference between the tonsillary ectopia and the criteria of these anomalies, the relationship between basilar invagination and platibasi was significant.
Correction of Microstomia Reconstruction With the Use of Acellular Dermal Matrix for Buccal Reconstruction
Authors: Wood Benjamin C. , Mantilla-Rivas Esperanza , Goldrich Agnes , Boyajian Michael K. , Oh Albert K. , Rogers Gary F. , Boyajian Michael J.
Published: February 2019

Correction of microstomia is challenging with a high rate of recurrence. We report the successful treatment of microstomia using acellular dermal matrix (ADM) as an adjunct for intraoral lining with >1 year of follow-up.

A 9-year-old international patient with severe immunodeficiency presented with severe microstomia because of recurrent oral infections. She had undergone 3 previous failed attempts to re-establish an adequate oral opening and was dependent on enteral nutrition via gastrostomy tube. She underwent release of the oral commissure scar contracture and orbicularis oris and the resultant mucosal defect was lined with ADM. A postoperative splint was used for 8 weeks. One-year follow-up demonstrated maintenance of the oral aperture with complete mucosalization of the ADM; the patient was able to resume oral diet and regular dental hygiene.

Mucosal reconstruction with ADM is a viable alternative to local flaps and in this case exhibited minimal soft tissue contraction.
Review of Endoscopic Repair of Mandible Fractures
Authors: Sanati-Mehrizy Paymon , Massenburg Benjamin B. , Sherif Rami D. , Ingargiola Michael J. , Motakef Saba , Taub Peter J.
Published: February 2019

Introduction:

Fractures of the mandibular condyle represent more than 30% of all mandible fractures. If required, reduction has been performed using either a closed or an open technique with similar outcomes. Endoscopic fracture repair is a minimally invasive approach for open reduction, but there is limited data regarding indications and outcomes. This study aims to systematically review the demographics, features, and outcomes following endoscopic repair of mandibular fractures in adult patients.

Methods:

The following databases were searched from their inception to December 31, 2016: PubMed, Cochrane, Web of Science, and the WHO Global Health Library, using terms related to endoscopy and mandibular fractures. Articles were screened and data were extracted by 2 independent reviewers. Disagreements arbitrated by discussion or a 3rd reviewer.

Results:

Twenty-two manuscripts were included, representing 509 adult patients who had endoscopic repair of a mandibular fracture over 18 years. All endoscopic repairs were of the mandibular condyle, including both subcondylar and condylar neck fractures. The sample-sized weighted mean age was 33.5 years with 74.5% males in the study population. Permanent facial nerve injury was reported once (0.24%) and occlusive complications reported in 31 patients (6.5%).

Conclusion:

This systematic review identifies a large cohort of patients who underwent endoscopic repair of their mandibular fractures. Complications were rare and usually temporary, with permanent complications occurring at a respectable rate. The demographics and outcomes identified in this study can be used as an epidemiologic baseline for future research on endoscopic repair of mandibular fractures.
Effects of a Preoperative Transdermal Fentanyl Patch on Proinflammatory Cytokine and Pain Levels During the Postoperative Period: A Randomized Controlled Trial
Authors: Kwon Youngsuk , Hwang Sung Mi , Jang Ji Su , Ryu Byoung Yoon , Kang Byung Yong , Kang Sang Soo , Lee Jae Jun
Published: February 2019

Objective:

The main objectives of this article were to assess the effect of preoperative transdermal fentanyl patch (TFP) on interleukin (IL)-6 and IL-8 levels and pain after laparoscopic cholecystectomy.

Materials and Methods:

Patients received a TFP (25 μg/h) (patch group, n=30) or a placebo patch (control group, n=30) applied 14 hours before operation. After surgery, control group received intravenous continuous fentanyl (25 μg/h) with loading dose (25 μg). IL-6 and IL-8 levels were measured at admission and 1, 6, 12, 24, and 48 hours postoperatively. Pain score and consumption of rescue analgesic were evaluated too.

Results:

At 24 hours postoperatively, IL-6 and IL-8 reached a peak and then decreased. The peak IL-6 levels were 21.92(±6.22) and 24.91(±6.81) pg/mL in the patch and control group. The significant differences of IL-6 between groups were shown at 6 and 12 hours postoperatively (P=0.032, 0.0001). There were no significant differences in IL-8 levels and pain score.

Conclusions:

Preoperative TFP attenuated the increase in IL-6 levels after surgery and provided similar analgesia to continuous fentanyl infusion. Preemptive TFP may have influence on proinflammatory reactions and pain control after surgery.
Concomitant Use of Indocyanine Green Fluorescence Imaging and Interventional Radiology for Detection of Liver Segments During Laparoscopic Anatomical Liver Resection: Pilot Feasibility Study
Authors: Ueno Masaki , Hayami Shinya , Sonomura Tetsuo , Kawai Manabu , Hirono Seiko , Okada Ken-ichi , Tanaka Ryota , Yamaue Hiroki
Published: February 2019

We investigate the feasibility of using indocyanine green (ICG) fluorescence imaging with interventional radiology (IVR) techniques for indication of liver segments during laparoscopic anatomical liver resection (LapAR). Ten patients with planned LapAR (segmentectomy V, VI, VII, or VIII) were enrolled. Both IVR and LapAR were performed in a hybrid operating room. Two dyes (indigo carmine and ICG) and embolic solutions were injected into the target liver segment. We compared imaging results during LapAR. ICG fluorescence imaging (ICGFI) provided clear visual contrast. Median contrast index value of ICGFI was 1.12, superior to that of indigo carmine (0.21; P=0.005). ICGFI was still visible during liver resection. Estimated liver resection volume and actual resected liver weight correlated significantly (R=0.906; P<0.01). ICGFI delivered by IVR provided clearer visual information than conventional indigo carmine dye, enabling precise performance of LapAR as planned (UMIN-CTR No. 000023952).
Laparoscopic Distal Pancreatectomy: Our Experience in a Tertiary Referral Center
Authors: Bademci Refik , Nunez Pedro S. , Temidayo Talabi Micheal O. , Blanco Manuel R. , Riart Gemma C. , Raventós Vicente A.
Published: February 2019

Background:

Despite an increase in the number of laparoscopic distal pancreatectomy (LDP) procedures being performed, the long-term oncology and operative results are still unclear. The aim of this study was to present the surgical and long-term results of patients undergoing LDP for the treatment of distal pancreatic tumors.

Materials and Methods:

A retrospective review was made of patients who underwent LDP in our clinic, between 2006 and 2018, and who were diagnosed with pancreas tail, neck, and corpus tumors. For the purposes of this study, the data related to the preoperative, operative, and postoperative characteristics of the patients were determined.

Results:

A total of 46 patients were identified as suitable for inclusion in the study. Of these, 52.1% were female individuals, and the average age of the whole group was 63 years. Previous surgery for malignant diseases was recorded for 54.3% of the patients, due to premalignant diseases in 13% and benign diseases in 32.7%. On average, 10 lymph nodes were removed from patients diagnosed with malignant tumors. The conversion rate was found to be 2.1%. The postoperative pancreatic fistula rate was 26%, and there was 1 complication each of grades III and IV according to the Clavien-Dindo classification. The mortality rate was 0%.

Conclusions:

It was concluded that LDP of distal pancreas tumors seems to be both safe and effective in respect of the long-term results in addition to the early results of the operation.
Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines?
Authors: Casaccia Marco , Sormani Maria P. , Palombo Denise , Dellepiane Clara , Ibatici Adalberto
Published: February 2019

The objective of this study was to derive some useful parameters to define the feasibility of laparoscopic splenectomy (LS) in massive [spleen longitudinal diameter (SLD)>20 cm] and giant spleens (SLD>25 cm). Between December 1996 and May 2017, 175 patients underwent an elective splenectomy. A laparoscopic approach was used in 133 (76%) patients. Massive spleens were treated in 65 (37.1%) patients, of which 24 were treated laparoscopically. In this subset of massive spleens, the results of laparoscopic splenectomy in massive spleens (LSM) and open splenectomy in massive spleens (OSM) were compared. The clinical outcome of a subgroup of patients with giant spleens was also analyzed. The LSM group resulted in significant longer operative times (143±31 vs. 112±40 min; P=0.001), less blood loss (278±302 vs. 575±583 mL; P=0.007), and shorter hospital stay (6±3 vs. 9±4 d; P=0.004). No conversions were experienced in the LSM group, and the morbidity rate was similar in both the LSM and OSM groups (16.6% vs. 20%; P=0.75). When considering the subset of 9 LSM patients and 26 OSM patients with giant spleens, the same favorable tendency of the laparoscopic group as regards surgical conversion, blood loss, and hospital stay was maintained. The laparoscopic approach can be successfully proposed in the presence of massive splenomegaly also after a careful preoperative evaluation of the expected abdominal “working space.” In experienced hands, LS is safe, feasible, and associated with better outcomes than open splenectomy for the treatment of massive and giant spleen, with a maximum SLD limit of 31 cm.
Diaphragmatic Hernia After Totally Laparoscopic Total Gastrectomy for Gastric Cancer
Authors: Gong Chung Sik , Ko Chang Seok , Kim Byung Sik , Kim Hee Sung
Published: February 2019

This study aimed to investigate the occurrence of diaphragmatic hernia (DH) after totally laparoscopic total gastrectomy (TLTG) for gastric cancer. We reviewed retrospectively collected data from 490 consecutive patients who underwent TLTG (functional method, 365; overlap method, 125) for upper body gastric cancer, between January 2011 and May 2017, performed by a single surgeon. The median follow-up period was 40.6 months. Of 490 patients, 8 (1.63%) developed DH at a mean interval after TLTG of 7.3 (range, 3.4 to 12.8) months. All 8 patients were from the functional group, and presented with abdominal pain or vomiting. They were managed with emergency surgery (5 laparoscopic hernia reduction, 3 open hernia reduction). The grade of complication according to Clavien-Dindo classification (CDC) was CDC-III in 7 cases and CDC-IV in 1 case. There was no death associated with DH complications. None of the patients in the overlap group developed DH. The incidence of DH after TLTG is negligible in the overlap method. Therefore, the overlap method may be a safe reconstruction technique that can reduce the occurrence of DC after TLTG for gastric cancer.
Predictors of Urinary Retention After Vesicovaginal Fistula Surgery: A Retrospective Case-Control Study
Authors: Chang Olivia H. , Pope Rachel J. , Sangi-Haghpeykar Haleh , Ganesh Prakash , Wilkinson Jeffrey P.
Published: February 2019

Objective

The objective of this study is to determine the predictors for urinary retention after vesicovaginal fistula surgery.

Methods

This was a retrospective case-control study of women who underwent vesicovaginal fistula repair between January 2014 and December 2017 at the Fistula Care Centre in Lilongwe, Malawi. Cases were defined as patients with documented urinary retention, defined as a postvoid residual that is 50% greater than the total void of at least 100 mL. The cases and controls were matched by the 3 components of the Goh classification system in a ratio of 1:5. Univariate analysis was used to detect differences between demographic, clinical characteristics, and operative techniques between cases and control. Logistic regression analysis was performed for estimation of odds ratios (ORs).

Results

There were no statistically significant differences between the 40 cases and 187 controls, when comparing age, gravidity, parity, body mass index, and length of postoperative catheterization. The median amount of postvoid residual noted at the time of diagnosis was 240 mL (range, 55–927 mL). Odds for urinary retention was 3 times higher among those with vertical closure than patients with horizontal closure of the bladder (OR, 2.91; 95% confidence interval, 1.35–6.20). Patients with prior fistula repairs were significantly less likely to develop urinary retention compared to those receiving surgery for the first time (OR, 0.27; 95% confidence interval, 0.10–0.67).

Conclusions

Vertical closure of the bladder and patients without a history of prior fistula repairs are predictors for developing urinary retention after fistula repair surgery.
Learning Styles and Motivations of Individuals Without Prior Exposure to Augmentative and Alternative Communication
Authors: Thiessen Amber , Beukelman David
Published: February 2019

Purpose:

Study purposes were to (a) examine achievement goal tendencies and learning mode preferences of adults who were unfamiliar with augmentative and alternative communication (AAC) facilitation, and (b) determine whether age and gender have an effect on these variables. Recruitment of untrained individuals allowed the researchers to simulate the experiences of individuals in the early stages of AAC facilitation.

Method:

Forty-one adults who were untrained in AAC facilitation completed surveys examining (a) achievement goal tendencies across 3 domains: mastery, performance, and social, and (b) learning mode preference across 4 domains: independent, small group, case study, and step-by-step. Participants were divided into groups on the basis of age (i.e., 26–40 years and 45–65 years) and gender (i.e., 16 males, 25 females).

Results:

Results indicate that participants were motivated to learn for mastery rather than social and performance purposes. In addition, they indicated a preference for learning through case studies. Younger adults rated performance and social learning higher than older adults. Also, women preferred small group instruction.

Discussion/Conclusions:

Facilitators play a vital role in successful AAC intervention, yet they often lack instruction to effectively fulfill this role. Clinicians should consider age and gender when designing instruction programs for these individuals.
Interprofessional Caregiver Education, Training, and Wellness in the Context of a Cohort Model for Aphasia Rehabilitation
Authors: Off Catherine A. , Griffin Jenna R. , Murray Kirsten W. , Milman Lisa
Published: February 2019

Patient-centered care is extending the sphere of health care beyond the patient, focusing attention upon the family caregiver(s). In this context, patient–family relationships are at the center of consistent, well-developed interprofessional interventions that encompass caregiver education, training, and wellness. Cohort models of intervention include groups of patients who start and stop a program or intervention simultaneously. One such cohort-based service delivery model is an intensive comprehensive aphasia program (ICAP), which provides an ideal context in which to address holistic care for the person with aphasia and his or her family caregivers. The interprofessional family caregiver intervention program of the ICAP at the University of Montana is twofold: (1) speech–language pathologists and graduate student clinicians in speech–language pathology provide family caregiver education and resources, communication training, and psychosocial support and (2) a licensed professional counselor and counselor-in-training provide group counseling for family caregivers focusing on personal wellness, caregiving strategies, emotional health, and adaptation to significant life changes. The fusion of equitable interprofessional collaboration, along with the cohort model of the ICAP, allows for acquisition of knowledge, communication strategies, and coping skills along with the development of close, meaningful relationships with other caregivers and persons with aphasia.
Third-Party Disability in Family Members of People With Communication Disorders Associated With Parkinson's Disease
Authors: Mach Helen , Baylor Carolyn , Hunting Pompon Rebecca , Yorkston Kathryn
Published: February 2019

The purpose of this study was to explore the impact of communication disorders on family members of people with Parkinson's disease (PD) through the lens of third-party disability. Nine community-dwelling family members who live with people with PD participated in semi-structured interviews. Data were collected and analyzed using the qualitative research methods from the tradition of phenomenology. Two themes emerged from the analysis of data. The first theme, “What?” captures examples of how communication between participants and their family members has changed because of PD, and how participants attempt to manage frequent communication breakdowns. Two subthemes address communication challenges related to changes in speech and changes in cognitive–linguistic skills, respectively, in their family members. The second theme, “It brings up things that have changed,” addresses the broader life impact that the communication changes have had on participants. The first subtheme describes how participants are changing their roles to take on more communication-related responsibilities in their households while still trying to maintain the dignity of their family members. The second subtheme reveals how participants experience grief and loss in that the decline in communication between themselves and their family members brings about a loss of connection with the person they may be closest to and, hence, changes their relationship with that person. Family members experience third-party disability related to communication disorders in their family members with PD. Some of these experiences are similar to third-party disability experienced by family members of people with other types of communication disorders. Better understanding of the extent and nature of third-party disability would help clinicians address the communication needs of both their clients with PD and their family members.
Loss of Intimacy
Authors: Stead Amanda , White John
Published: February 2019

The sudden loss of intimacy can have a dramatic effect on satisfaction in a relationship. As many caregivers shift roles and try to personally adjust to their new reality, a steep drop in intimacy can often simultaneously occurs. Aphasia presents a significant barrier to opening discussions about intimacy and sexual contact. The purpose of this article is to discuss the current literature regarding intimacy in aphasia and present solutions for addressing this complex issue. One of the simplest solutions to addressing this gap in care is having rehabilitation professionals introduce these topics early in the rehabilitation process. This is optimally achieved through interdisciplinary training in the use of effective supported communication strategies for persons with aphasia. Another solution is to create community-centered events that allow couples to address issues related to intimacy after rehabilitation ends. This article describes one such program, an Aphasia Couples Retreat, ran as a collaboration between a local nonprofit and university program in the Pacific Northwest. The retreat provides couples with the opportunity to discuss and address issues related to intimacy, learn new skills, and gain support from an interdisciplinary team of students, speech–language pathologists, occupational therapists, and psychologists.
Family-Centered Care in Aphasia
Authors: Grawburg Meghann , Howe Tami , Worrall Linda , Scarinci Nerina
Published: February 2019

More than 50 years of research has demonstrated the profound effect that aphasia has on people with the condition and their family members. In the International Classification of Functioning, Disability and Health, the World Health Organization described the impact of an individual's health condition on a significant other as “third-party disability.” Recent research has described how third-party disability can occur in family members of people with aphasia post-stroke. Despite the extensive history and ongoing relevance of these findings, family-centered rehabilitation has been slow to integrate into clinical practice and policy. The aims of this article are (1) to provide an overview of third-party disability in family members of people with aphasia; (2) to consider how third-party disability can be addressed through family-centered care and to identify some of the barriers to family-centered care; and (3) to describe The Family Aphasia Measure of Life Impact (FAMLI), a tool for measuring third-party functioning and disability in family members of people with aphasia, identifying family rehabilitation needs, and measuring outcomes of family-centered care.
Biliary Complications Following Pediatric Living Donor Liver Transplantation: Risk Factors, Treatments, and Prognosis
Authors: Sanada Yukihiro , Katano Takumi , Hirata Yuta , Yamada Naoya , Okada Noriki , Ihara Yoshiyuki , Mizuta Koichi
Published: February 2019

Background.

We present retrospective analysis of our 15-year experience with pediatric living donor liver transplantation, focusing on the risk factors, treatments, and long-term prognosis for posttransplant biliary complications (BCs).

Methods.

Between May 2001 and December 2017, 290 living donor liver transplantations were performed. The median age was 1.4 years old. The median observation period was 8.4 years. Biliary strictures were classified as anastomotic stricture (AS) or non-AS (NAS).

Results.

Overall incidence of biliary complications was 18.6%, including AS in 46 cases, NAS in 6, and other classifications in 2. The mean period to diagnosis of the AS was 641 ± 810 postoperative days. The multivariate analysis showed that hepaticojejunostomy without external stent was an independent risk factor for AS (P = 0.011). The first treatments for AS were percutaneous transhepatic biliary drainage (PTBD) in 25 cases, double-balloon enteroscopy (DBE) in 19, and surgical reanastomosis in 2. The success and recurrence rates of PTBD treatments were 90.9% and 22.7%, respectively. The success and recurrence rates of endoscopic interventions under DBE were 93.6% and 75.3%, respectively. The 15-year graft survival rates in patients with and without AS were 95.7% and 89.1%, respectively (P = 0.255), but 2 patients with cholangitis due to multiple NAS underwent retransplantation.

Conclusions.

Posttransplant AS can be prevented by hepaticojejunostomy using external stent, and the long-term prognosis is good with early treatments using DBE or PTBD. However, the prognosis of multiple NAS is poor.
Racial/Ethnic Disparities in Access and Outcomes of Simultaneous Liver-Kidney Transplant Among Liver Transplant Candidates With Renal Dysfunction in the United States
Authors: Chang Su-Hsin , Wang Mei , Liu Xiaoyan , Alhamad Tarek , Lentine Krista L. , Schnitzler Mark A. , Colditz Graham A. , Park Yikyung , Chapman William C.
Published: February 2019

Background.

Since the Model for End-stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. However, whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival remains understudied.

Methods.

A retrospective cohort of patients aged ≥18 years with renal dysfunction on the liver transplant (LT) waiting list was obtained from Organ Procurement and Transplantation Network. Renal dysfunction was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 at listing for LT. Multilevel time-to-competing-events regression adjusting for center effect was used to examine the likelihood of receiving SLKT. Inverse probability of treatment weighted survival analyses were used to analyze posttransplant mortality outcomes.

Results.

For patients with renal dysfunction at listing for LT, not listed for simultaneous kidney transplant, non-Hispanic black (NHB) and Hispanic patients were more likely to receive SLKT than non-Hispanic white (NHW) patients (NHB: multivariable-adjusted hazard ratio [aHR] 2.57; 95% confidence interval [CI], 1.42-4.65; Hispanic: aHR, 2.03; 95% CI, 1.14-3.60). For post-SLKT outcomes, compared to NHW patients, NHB patients had a lower mortality risk before 24 months (aHR, 0.80; 95% CI, 0.65-0.97) but had a higher mortality risk (aHR, 2.00; 95% CI, 1.59-2.55) afterward; in contrast, Hispanic patients had a lower overall mortality risk than NHW patients (aHR, 0.61; 95% CI, 0.51-0.74).

Conclusions.

In the MELD era, racial/ethnic differences exist in access and survival of SLKT for patients with renal dysfunction at listing for LT. Future studies are warranted to examine whether these differences remain in the post-SLK allocation policy era.