bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Introduction of a Laparoscopic Liver Surgery Programme: A Cost Analysis of Initial Experience in a University Hospital
Authors: Stoot J. H. M. B. , van Dam R. M. , Coelen R. J. S. , Winkens B. , Damink S. W. M. Olde , Bemelmans M. H. A. , Dejong C. H. C. 
Published: March 2013

Background and Aims In the era of expanding costs of healthcare, this study was conducted to perform a cost analysis of introducing a laparoscopic liver surgery programme for left sided liver lesions. Materials and Methods Consecutive patients treated by laparoscopic liver resections of left lateral segments were included. Controls were a group of 14 patients undergoing open resection for similar pathology. Primary outcomes were costs. Secondary outcomes were complications, conversions, blood loss, length of operation, and length of hospital stay. Results The laparoscopic approach for hepatic left lateral resection (bisegmentectomy 2 and 3) was performed in fourteen patients (group I, median age 54 [range 26–82] years). In the open group, fourteen patients from a prospectively collected database with the same type of resection were selected (group II, median age 64 [range 29–76] years). Costs of theatre usage in the laparoscopic group were significantly lower (p = 0.031). No significant differences in costs of disposable instruments, ward stay and total costs were observed between the two groups. There were three complications in the laparoscopic group compared with two complications in the open group. In the laparoscopic group there were 2 conversions (14%). Median blood loss was significantly lower in the laparoscopic group (50 mls [range 0–750], (p = 0.001) versus the open group (500 mls [range 150–750]). Furthermore, operation time was also significantly lower in the laparoscopic group (116 [range 85–261] minutes) versus the open group (165 [range 96–217] minutes, p = 0.016). Median length of stay was 6 [range 4–11] days in group I versus 6 [range 5–13] days in group II (p = 0.508). Conclusion Costs of laparoscopic liver resections proved to be equivalent to open surgery. Furthermore, implementation of a laparoscopic liver resection programme seems feasible and safe with reduced blood loss and operation time and comparable morbidity and length of stay.
Preliminary Study Analyzing the Methylated Genes in the Plasma of Patients with Pancreatic Cancer
Authors: Park J. W. , Baek I. H. , Kim Y. T. 
Published: March 2013

Background and Aims CpG islands of the promoter region of some genes are methylated in pancreatic cancer tissue and the detection of this methylation has been suggested to be useful in the diagnosis of various cancers. The aim of this study was to investigate whether the detection of methylated CpG islands in plasma can be used in the diagnosis of pancreatic cancer. Material and Methods Plasma DNA was collected from patients with pancreatic cancer, chronic pancreatitis, and healthy controls. The methylation status of six genes, UCHL1, NPTX2, SARP2, ppENK, p16, and RASSF1A, was checked by methylation-specific PCR and was subsequently confirmed by direct sequencing after bisulfite treatment. Results CpG island methylation was detectable in 13 of 16 patients (81.3%) with pancreatic cancer, 1 of 29 healthy controls (3.5%), and 8 of 13 patients with chronic pancreatitis (61.5%). The mean number of genes with CpG island methylation was 1.6 ± 1.2 in pancreatic cancer, 0.04 ± 0.19 in healthy controls, and 1.2 ± 1.1 in chronic pancreatitis. Among six genes, p16 was more specifically methylated in pancreatic cancer compared with chronic pancreatitis ( p = 0.016). The methylation status was not correlated with smoking history, tumor size, or cancer stage. Conclusions The detection of methylated genes in the plasma may have a role in differentiating between pancreatic cancers and healthy controls but not between pancreatic cancer and chronic pancreatitis.
Characteristics and Differences in Necrotizing Fasciitis and Gas Forming Myonecrosis: A Series of 36 Patients
Authors: Tilkorn D. J. , Citak M. , Fehmer T. , Ring A. , Hauser J. , Benna S. Al , Steinstraesser L. , Roetman B. , Steinau H.-U. 
Published: March 2013

Background and Aims Necrotizing fasciitis (NF) and gas forming myonecrosis (GFM), both being subtypes of necrotizing soft tissue infection (NSTI), are life threatening conditions sharing certain similarities. Despite the necessity of early and radical surgical debridement in necrotizing infections, the distinction between these entities is of clinical relevance since gas forming myonecrosis in a number of cases results from an underlying abdominal cause and the focus of infection can be missed. This study was to evaluate the incidence and risk factors as well as the mortality rate in patients with NSTI and GFM. Material and Methods All patients with NSTI treated in the authors' hospital between January 2005 and December 2009 were enrolled in the study. Medical records, histological slides, microbiological and laboratory parameters as well as Computerized Tomography (CT) and magnetic resonance imaging (MRI) scans were reviewed for all patients. Differences between NF and GFM regarding hospital stay, number of surgical interventions and pre-existing comorbidities as well as mortality rate were analyzed. The laboratory risk factor for necrotizing fasciitis (LRINEC) score was calculated in all patients on admission. Results and Conclusions Thirty patients (17 female, 13 male) with necrotizing fasciitis with a mean age of 55 years (SD 15.5) were included in the study. There was no statistically significant difference between survivors and deceased patients comparing the LRINEC score (n.s.). Patients with necrotizing fasciitis secondarily involving the trunk had a significantly higher mortality rate (OR 11.2; 95% CI = 1.7–72.3). In the majority of cases (12 cases), minor skin lesions were identified as the site of origin. Amongst all necrotizing soft tissue infections six patients (female n = 3; male n = 3) with a mean age of 61.5 years (SD 12.2) with non-clostridial gas forming myonecrosis were identified. Three patients had a history of malignancy and in three patients the infection was secondary to major surgery. The mean LRINEC score was 8.5 (SD 1). Three patients (50%) died due to GFM. Early diagnosis and appropriate intervention is critical to provide accurate treatment decisions. Eradicating the differing primary sources of infection in GFM and NF will have a positive impact on outcome.
Posterolateral Spondylodesis Using Bioactive Glass S53P4 and Autogenous Bone in Instrumented Unstable Lumbar Spine Burst Fractures
Authors: Rantakokko J. , Frantzén J. P. , Heinänen J. , Kajander S. , Kotilainen E. , Gullichsen E. , Lindfors N. C. 
Published: March 2013

Background and Aims A prospective long-term follow-up study of bioactive glass (BAG)-S53P4 and autogenous bone (AB) used as bone graft substitutes for posterolateral spondylodesis in treatment of unstable lumbar spine burst fractures during 1996–1998 was conducted. Material and Methods The lumbar fractures were fixed using posterior USS instrumentation. BAG was implanted on the left side of the fusion-bed and AB on the right side. The operative outcome was evaluated on X-rays and CT scans, and a clinical examination was also performed. Results The Oswestry score was excellent, and the mean pain score 1. The mean compression rate of the injured vertebral body was 25%. A solid bony fusion was seen on CT scans on the AB side in all patients and on the BAG side in five patients, and a partial fusion in five patients, resulting in a total fusion-rate of 71% of all fused segments in the BAG group. Conclusions Our long-term results show that BAG-S54P4 bone graft material is safe to be used as a bone graft extender in spine surgery.
Hybrid Procedures as a Novel Technique in the Treatment of Critical Limb Ischemia
Authors: Aho P.-S. , Venermo M. 
Published: March 2013

In hybrid reconstructions, patients are treated using both endovascular and open revascularization techniques simultaneously. In recent years, these multilevel reconstructions have been increasingly used especially by vascular surgeons as they have adopted new knowledge and endovascular skills and the endovascular techniques have evolved. The first reports of combined endovascular and open surgical procedures are from the 1970s. Since then, most reports have dealt with femoral endarterectomy or femoro-femoral bypass combined with inflow iliac percutaneous transluminal angioplasty (PTA) and stenting. Primary success rates have been high: 93%–100%. In our institution 213 hybrid procedures were performed during 2003–2011 with 98.6% technical success rate. The annual number of hybrid procedures ranged from 4 in 2004 to 73 in 2011. Inflow endovascular procedure was performed in 60% and outflow in 40 % of the cases. The proportion of the endovascular component performed by vascular surgeons increased from 0% in 2004 to 86.3% in 2011. In the current report we review the results published in the literature, report our own experience and present some technical notes and cases.
Perioperative Morbidity, Mortality and Early Outcome of the First 360 Gastric Bypass Operations Performed in a District Hospital
Authors: Victorzon M. , Peromaa-Haavisto P. , Tolonen P. 
Published: March 2013

Background and Aims: We report the results for the first consecutive 360 Roux-en-Ygastric bypass (RYGB) operations performed in a district hospital in Finland. Material and Methods: Demographic data, perioperative characteristics, and follow-up data were entered prospectively in the hospital's database for bariatric patients. Results: We performed 325 primary laparoscopic Roux-en-Ygastric bypass (LRYGB) operations, one open RYGB, and 34 revisions. Mean BMI before the operations was 47.5 ± 7.8 kg/m2 (31.5–91.0 kg/m2). The percentage of patients with type 2 diabetes mellitus (T2DM) was high; 52.3% (170 patients). The mean operative time decreased from 110 minutes during the first 108 operations to 82 minutes for the second 108 operations, and to 74 minutes for the last 109 operations (P < 0.001). Postoperative hospital stay was significantly reduced (P < 0.001) for the last 109 patients compared to the first and second group of patients. Overall morbidity averaged 19.1% (62/325). Severe complications were detected in 15 patients (4.6%). There was a tendency to more serious complications in the first group of patients. There was one death (mortality 0.3%). With a follow-up rate of 97% at 3 months T2DM had resolved in 48.2%, and had resolved or improved in a minimum of 92.9% of the diabetic patients. Weight loss (WL) and excess weight loss (EWL) averaged 20% and 46% respectively. Conclusions: Operative time and postoperative hospital stay decrease significantly with increasing experience. The first one hundred patients may be at higher risk for complications. LRYGB operations may have an important impact on the resolution of T2DM in the operated population.
Increased Energy Intake in Hip Fracture Patients Affects Nutritional Biochemical Markers
Authors: Gunnarsson A.-K. , Åkerfeldt T. , Larsson S. , Gunningberg L. 
Published: March 2013

Background and Aims: We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications. Material and Methods: Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection. Results: The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term postoperative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission. Conclusion: The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively.
Femoral Neck Bone Mineral Density after Resurfacing Hip Arthroplasty
Authors: Tapaninen T. , Kröger H. , Jurvelin J. , Venesmaa P. 
Published: March 2013

Introduction: Resurfacing hip arthroplasty (RHA) has been suggested to provide an alternative to conventional total hip arthroplasty in younger, active patients. It seems to have an ability to conserve the bone mass on the femoral side. Some controversy exists regarding to the possible disadvantages of RHA and some of them are connected to poor femoral bone quality after surgery. Hence we wanted to study the bone mineral density changes 3 and 12 months after RHA. Materials and Methods: A total of 26 patients (22 men and 4 women, 28 hips) underwent a hip resurfacing arthroplasty. The mean age of the patients was 55,2 (range 38–69) years. Bone mineral density (BMD) of the proximal femur was measured by using the dual-energy X-ray absorptiometry (DXA) postoperatively and within 3 and 12 months from surgery. For analysis, we divided the femoral neck area into four equal-sized regions of interest ranging from the prosthesis to the trochanter level. Results: At three months follow-up the BMD changes varied between −5.1% (ROIC) and + 1.9% (ROIA), as compared with the immediate postoperative values. After one year follow-up the BMD changes were + 1.1% in the ROIA, + 5.4% in the ROIB, −3.9% in the ROIC and + 1.3% in the ROID. The changes in BMD were not statistically significant. Discussion: While there is still much debate and room for additional research in this topic, the results suggest that BMD is conserved in the femoral neck one year after hip resurfacing arthroplasty.
A Critical Analysis of Postoperative Complications of Antebrachium Ten-Nailing in 35 Children
Authors: Salonen A. , Salonen H. , Pajulo O. 
Published: March 2013

Background: Unstable antebrachium diaphyseal fractures in children are nowadays increasingly treated operatively by elastic intramedullary nailing. Aim: Aim of the study was to critically assess both radiological and functional outcome of antebrachium fractures treated by titanium elastic nail (TEN) in a pediatric cohort. Material and Methods: This retrospective study investigated 75 consecutive children, who were treated for antebrachium shaft fractures at Tampere University Hospital during the time period from January 2001 to December 205. All the fractures were classified according to OTA. Thirty-five children (mean age 12.3 years) were treated by TEN-nailing. Twenty four of the forearm fractures were instable, five were open, five were re-fractures and one had ulnar nerve deficit. In all but one patient both forearm bones were fractured. Twelve (34%) operations were managed by closed reduction, open reduction was needed in 23 (66%) patients. In 29 cases both bones were fixed with TEN-nail. In the four patients with re-fracture in both ulna and radius only the radius was TEN-nailed. In one case radius was fixed with TEN-nail and ulna with K-wire and in another case radius was fixed with TEN-nail and ulna with plate. Fracture pattern, mode of reduction, surgical approach, short- and long-term complications and outcome were recorded. Results: Twenty three (66%) patients achieved healing of the fractures without any limitation in range of motion. Twelve patients with postoperative complication were followed up 31–74 (median of 54) months. Eleven (31%) patients had minor postoperative complications and one (0,3%) patient had a Volkmann's ischemic contracture. Five of complicated patients had more than one problem. Immediate post-operative problems were noted in these five patients. At follow-up visits four patients complained of ulnar nail discomfort, two had neural symptoms. Additionally, three children suffered from re-fractures. Discussion: Despite various minor complications, TEN-nailing is considered suitable treatment for unstable forearm shaft fractures. Most of the problems were related to poor technical performance in nailing.
Successful Femoral Reconstruction with a Fluted and Tapered Modular Distal Fixation Stem in Revision Total Hip Arthroplasty
Authors: Skyttä E. T. , Eskelinen A. , Remes V. 
Published: March 2013

Background and Aims: Early results of fluted and tapered distal fixation stems used in reconstruction of deficient femora in femoral revision arthroplasty have been successful in small series. We evaluated the survival of the LINK MP Reconstruction Hip Stem and factors associated with survival using data from a nation-wide arthroplasty register. Materials and Methods: 408 femoral revisions using LINK MPReconstruction Hip Stem were performed during 1994 to 207. The mean age of the patients was 72.5 (range: 36–93) years and 63% were performed in women. Kaplan-Meier analysis and the Cox regression model were used for the survival analysis. The effects of age, sex and diagnoses were also studied. Results: The 9-year overall survivorship for the LINK MPReconstruction Hip Stem was 75% (95% CI 70–80). Aseptic loosening was rare; the 9-year revision rate for aseptic loosening was only 3%, which coincides with earlier reports with shorter folllow-up. The most common reason for re-revision was dislocation of the prosthesis with or without malposition of the socket (67%). Indication for revision strongly affected the survival rate with revisions for dislocation having an over 3-fold and revisions for infection a 3-fold relative risk for re-revision compared to revisions for aseptic loosening. Increasing age slightly decreased the risk of re-revision but sex did not affect the survival. Discussion: Based on our findings, we conclude LINK MP Reconstruction Hip Stem, as an example of a fluted and tapered distal fixation stem, appears to solve many problems with implant fixation in femoral revisions. High number of dislocations suggests that special attention should be paid to correct center of rotation, to correct implant positioning and to need of constrained implants in case of deficient abductor mechanism.
The Role of Hybrid Procedures in the Management of Peripheral Vascular Disease
Authors: Balaz P. , Rokosny S. , Bafrnec J. , Björck M. 
Published: March 2013

This paper provides a summary of up-to-date information and experience with the combined treatment of patients suffering from peripheral arterial disease (PAD) with endovascular and open surgery, performed simultaneously and in a single operating room. Hybrid intervention is reported to have good results in well-indicated groups of patients with acute and chronic limb ischemia, even with older, high-risk patients. The indications for the use of this technique remain unclear with inconsistent opinions among vascular surgeons. The indications for treatment were divided into three main groups: 1) Patients with chronic limb ischemia, 2) acute limb ischemia, and 3) occlusion of a previous vascular reconstruction. The operating techniques for the most commonly used combinations are described. In conclusion, hybrid operating techniques are often useful when treating complex problems and multilevel disease in patients with chronic or acute lower limb ischemia. Modern vascular surgeons need to master both open and endovascular techniques, and to combine them in a creative fashion to the benefit of our patients.
Periprosthetic Bone Turnover after Primary Total Hip Arthroplasty Measured by Single-Photon Emission Computed Tomography
Authors: Venesmaa P. , Vanninen E. , Miettinen H. , Kröger H. 
Published: March 2013

Background and Aims: Alterations in periprosthetic bone are common sequlae of prosthetic implants. This prospective 3-year study was performed to follow regional periprosthetic bone turnover after uncomplicated total hip arthroplasty (THA) using single-photon emission computed tomography (SPECT). Material and Methods: Eighteen patients (nine men, nine women: mean age 61 years, range from 50 to 73 years) with primary hip osteoarthritis underwent either uncemented or cemented THA. The SPECT measurements were taken 6, 12, and 36 months after THA. B one mineral density (BMD) measurements were performed on the patients during follow-up. Results: The mean SPECT uptake ratios decreased significantly in the regions of interest (ROIs) during follow-up compared to baseline value, in the trochanter major (p = 0.006), the trochanter minor (p = 0.009) and the total area (p = 0.018). Despite these decreases the uptake ratios in the medial cortex (p = 0.014), tip (p = 0.002) and total area (p = 0.016) remained significantly higher in the operated side than in the contralateral side (non-operated) 3 years after THA. Changes in bone turnover in the vicinity of the implant did not correlate with changes in periprosthetic BMD. Conclusions: Local periprosthetic bone turnover decreased slowly after THA and did not recover to the level typical of non-operated hips. This led us to suggest that bone turnover around the femoral implants remains increased more than 3 years after THA even if there are no signs of failure of the prosthesis.