Articles: surgery.
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Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 virus, is now generating a global epidemic, leading to a severe public health emergency. Until April 12, 2020 around 1,700,954 confirmed cases and 105,633 deaths have been reported all over the world. ⋯ China has achieved an inspiring achievement on epidemic control. Here, we reviewed available studies on surgical activities during the outbreak, in combination with our current experience, with the aim of providing feasible suggestions on surgical issues during the COVID-19 pandemic.
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Surgical reduction of pelvic dislocation is a challenging procedure with poor long-term prognosis if reduction does not accurately restore natural morphology. The procedure often requires long fluoroscopic exposure times and trial-and-error to achieve accurate reduction. We report a method to automatically compute the target pose of dislocated bones in preoperative CT and provide 3D guidance of reduction using routine 2D fluoroscopy. ⋯ The method demonstrated accurate estimation of the target reduction pose in simulation, phantom, and a clinical feasibility study for a broad range of dislocation patterns, initialization error, dose levels, and FOV size. The system provides a novel means of guidance and assessment of pelvic reduction from routinely acquired preoperative CT and intraoperative fluoroscopy. The method has the potential to reduce radiation dose by minimizing trial-and-error and to improve outcomes by guiding more accurate reduction of joint dislocations.
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Stereotactic navigation and functional magnetic resonance imaging (fMRI) are increasingly used as important tools for intraoperative guidance and preoperative mapping for lesions in eloquent areas. We report a case in which a WHO grade II oligodendroglioma in Broca's area with functional activation was successfully resected with the support of blood-oxygen-level-dependent imaging (BOLD)-fMRI mapping in a patient who refused an awake craniotomy. This case highlights key principles of tumor surgery navigation. Specifically, it calls into question the utility of awake craniotomy in this modern era. Ultimately, fMRI is an important tool for tumor resections and can limit the need for more expensive or invasive measures.
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European urology focus · Jul 2020
Persistent Opioid Use Among Patients with Urolithiasis: A Population based Study.
Urolithiasis can result in acute, short-lived pain for which opioids are often prescribed. The risk of persistent opioid use following an initial presentation for urolithiasis is unknown. ⋯ In this study we found that 9% of patients prescribed opioids at presentation for kidney stones filled an additional prescription 3-6 mo later. Risk factors for this continued use included a higher dose of opioids prescribed in the initial period and the type of kidney stone surgery.