Therapeutics and clinical risk management
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Ther Clin Risk Manag · Jan 2016
Comparison of anterior decompression and fusion versus laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis.
A meta-analysis was conducted to evaluate the clinical outcomes, complications, reoperation rates, and late neurological deterioration between anterior decompression and fusion (ADF) and laminoplasty (LAMP) in the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL). ⋯ Our meta-analysis suggested that ADF was associated with better postoperative neurological function, neurological recovery rate, and less late neurological deterioration than LAMP in the treatment of multilevel cervical OPLL with a high mean occupation ratio. LAMP was associated with a decreased postoperative cervical lordosis, which might be a cause of late neurological deterioration. The complication rates of both groups showed no statistical difference. However, the reoperation rate was significantly higher in ADF group compared with LAMP group. Benefits and risks should be balanced when ADF or LAMP is selected.
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Ther Clin Risk Manag · Jan 2016
Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study.
Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). To date, no reports compare the efficacy of spinal anesthesia (SA) with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA. ⋯ TEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better patient satisfaction than GA.
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Ther Clin Risk Manag · Jan 2016
Kinetics of circulating endothelial progenitor cells in patients undergoing carotid artery surgery.
Endothelial progenitor cells (EPCs) are primitive cells found in the bone marrow and peripheral blood (PB). In particular, the potential of EPCs to differentiate into mature endothelial cells remains of high interest for clinical applications such as bio-functionalized patches for autologous seeding after implantation. The objective of this study was to determine EPCs' kinetics in patients undergoing carotid artery thromboendarterectomy (CTEA) and patch angioplasty. ⋯ CTEA results in short-term downregulation of circulating EPCs and SDF-1α levels. Rapid return to baseline levels might indicate participation of EPCs in repair mechanisms following vascular injury.
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Ther Clin Risk Manag · Jan 2016
Comparison of the glottic view during video-intubation in super obese patients: a series of cases.
Videolaryngoscopes improve the view of the entry to the larynx in morbidly obese patients. Super obesity is one of the risk factors for difficult mask ventilation as well as difficult intubation. Super obese patients should be intubated awake either with a fiber-optic scope or with a videolaryngoscope. ⋯ All obtained images were analyzed using the Percentage of Glottic Opening (POGO) scale. The POGO score for the MGM was better than for the KV and the APA but comparable to the Airtraq device. The images were processed electronically, and the best view of the laryngeal inlet that was obtained by the evaluated devices in the same patient was superimposed onto the other one and then compared.
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Ther Clin Risk Manag · Jan 2016
Does surgical treatment within 4 hours after trauma have an influence on neurological remission in patients with acute spinal cord injury?
The proper timing for surgery in patients with acute spinal cord injury is controversial. This study was conducted to detect if there is an advantage in early (within the first 4 hours after trauma) compared to late (between 4 and 24 hours after trauma) surgery on neurological outcome. ⋯ In our study, all patients with spinal cord injury were treated with spine stabilization and decompression within the first 24 hours after trauma. Surgical decompression within the first 4 hours after trauma was not associated with improved neurological outcome compared to treatment between 4 and 24 hours. In a clinical context, this indicates that there is a time frame of at least 1 day in which optimal care is possible.