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Surgical management of complicated diverticulitis: systematic review and individual patient data network meta-analysis : An EAES/ESCP collaborative project
No full textBACKGROUND
We performed a systematic review and network meta-analysis (NMA) of individualized patient data (IPD) to inform the development of evidence-informed clinical practice recommendations.
METHODS
We searched MEDLINE, Embase, and Cochrane Central in October 2023 to identify RCTs comparing Hartmann's resection (HR), primary resection and anastomosis (PRA), or laparoscopic peritoneal lavage (LPL) among patients with class Ib-IV Hinchey diverticulitis. Outcomes of interest were prioritized by an international, multidisciplinary panel including two patient partners. Article screening, data extraction for IPD, and risk of bias appraisal were performed by two reviewers. We used a random-effects NMA to synthesize direct and indirect evidence. Heterogeneity was evaluated using the I statistic. The panel appraised the certainty of the evidence using GRADE and CINeMA.
RESULTS
Fourteen reports of seven RCTs were derived from 4,659 articles. IPD data were available for 595/678 patients (88.8%) across trials. Patients had a mean age ± SD of 64.61 ± 13.64 years and a mean BMI ± SD of 26.12 ± 5.20 kg/m, representing Hinchey classes I (1.2%), II (1.0%) III (76.3%), and IV (12.1%), respectively. Using minimal important difference thresholds, in-hospital/30-day mortality was higher among patients receiving LPL versus HR [42 more per 1000, 95% CI (41 fewer to 331 more), moderate effect; low certainty] as well as PRA [45 more per 1000 patients, 95% CI (33 fewer to 340 more) moderate effect; low certainty] without heterogeneity (I = 0%). Among 417 patients from four trials, there was a lower stoma rate among patients receiving PRA versus LPL [539 fewer per 1000, 95% CI (647 fewer to 306 fewer), large effect; low certainty].
CONCLUSION
PRA likely confers a lower stoma rate at 1 year compared to HR, while there may be no difference in 30-day/in-hospital mortality. LPL likely confers a higher in-hospital/30-day mortality rate compared to HR and PRA
Efficacy of collagenated bone substitutes for bone regeneration in two-wall-damaged extraction sockets without barrier membranes
No full textOBJECTIVES
To evaluate ridge dimensional changes following alveolar ridge augmentation in two-wall-damaged extraction sockets without a barrier membrane, using two types of collagenated bone substitutes i. cross-linked (CL-CB) and ii. non-cross-linked (NCL-CB).
MATERIALS AND METHODS
Two-wall defects were created in mandibles of seven beagle dogs and treated in three groups: (i) no grafting (control), (ii) sockets filled with NCL-CB, and (iii) sockets filled with CL-CB. No barrier membrane was used. One animal was sacrificed after 1 week of healing for tissue assessments (n = 1), and the other six were sacrificed after 8 weeks of healing for microcomputed tomography (micro-CT) and histological analyses (n = 6).
RESULTS
Compared to unextracted sites, radiographic analysis revealed that the alveolar ridge dimension decreased to 83.29 ± 24.96% in group NCL-CB, 73.46 ± 16.59% in group CL-CB and 55.41 ± 12.95% in non-grafted sites (intergroup p = 0.062). Histological analysis showed that compared to baseline values the ridge area decreased to 68.75 ± 14.20% in the non-grafted group, 79.88 ± 20.05% in the NCL-CB group and 76.10 ± 21.09% in the CL-CB group with no significant differences between the groups (p > 0.05). Qualitative histological analyses revealed significantly less mineralized tissue in both test groups, amounting to 25.28 ± 10.40% in group NCL-CB, 29.86 ± 12.04% in group CL-CB, and 67.15 ± 14.35% in non-grafted sites (intergroup p < 0.05).
CONCLUSION
The efficacy of alveolar ridge augmentation using either cross-linked or non-cross-linked collagenated bone substitutes alone might be limited in severely damaged sockets such as those with two-wall defects.
CLINICAL RELEVANCE
In situations where sockets are extensively damaged, like those with two-wall defects, relying solely on soft-type bone block substitutes without a barrier membrane may not provide sufficient bone regeneration. This study highlights the importance of considering additional regenerative strategies, such as the use of barrier membranes, to enhance clinical outcomes
Neonatal Transcatheter Closure of a Large Pulmonary Arteriovenous Fistula with a KONAR-MF™ VSD Occluder
No full textPulmonary arteriovenous fistulas (PAVFs) are rare congenital anomalies characterized by abnormal vascular connections that bypass the capillary bed, causing hypoxemia, cyanosis, and systemic embolic risks. Early diagnosis and intervention are critical to prevent complications, particularly in neonates with severe right-to-left shunts. This report describes the first documented case of neonatal transcatheter closure of a large PAVF using a KONAR-MF™ VSD Occluder (MFO). A 1-day-old neonate with a prenatally diagnosed PAVF presented with oxygen saturation of 82%. Angiographic and echocardiographic assessments confirmed the presence of a large PAVF between the right pulmonary artery and right inferior pulmonary vein. The fistula was successfully closed using an 8 × 6 mm MFO device, with no complications. Post-procedure, oxygen saturation improved to 100%, and follow-up at 5 months demonstrated sustained closure. This report highlights the safety and versatility of the MFO occluder in complex cardiac cases, offering a minimally invasive alternative to surgical intervention
Buchbesprechung zu Andreas Heinz (2023): Das kolonialisierte Gehirn und die Wege der Revolte
No full text
Multimodality Management of Thoracic Tumors: Initial Experience With a Multidisciplinary Thoracic Ablation Conference
No full textBACKGROUND: This study aimed to describe lesion-specific management of thoracic tumors referred for consideration of image-guided thermal ablation (IGTA) at a newly established multidisciplinary ablation conference.
METHODS: This retrospective single-center cohort study included consecutive patients with non-small cell lung cancer (NSCLC) or thoracic metastases evaluated from June 2020 to January 2022 in a multidisciplinary conference. Outcomes included the management recommendation, treatments received (IGTA, surgical resection, stereotactic body radiation therapy [SBRT], multimodality management), and number of tumors treated per patient. Pearson's chi-square test was used to assess for a change in management, and Poisson regression was used to compare the number of tumors by treatment received.
RESULTS: The study included 172 patients (58 % female; median age, 69 years; 56 % thoracic metastases; 27 % multifocal primary lung cancer; 59 % ECOG 0 [range, 0-3]) assessed in 206 evaluations. For the patients with NSCLC, IGTA was considered the most appropriate local therapy in 12 %, equal to SBRT in 22 %, and equal to lung resection in 3 % of evaluations. For the patients with thoracic metastases, IGTA was considered the most appropriate local therapy in 22 %, equal to SBRT in 12 %, and equal to lung resection in 3 % of evaluations. Although all patients were referred for consideration of IGTA, less than one third of patients with NSCLC or thoracic metastases underwent IGTA (p < 0.001). Multimodality management allowed for treatment of more tumors per patient than single-modality management (p < 0.01).
CONCLUSIONS: Multidisciplinary evaluation of patients with thoracic tumors referred for consideration of IGTA significantly changed patient management and facilitated lesion-specific multimodality management
Remineralization of post-orthodontic white spot lesions with a fluoride varnish and a self-assembling P 11 - 4 peptides: a prospective in-vivo-study
No full textOBJECTIVE
The objective was to evaluate the remineralization effects of fluoride varnish (Clinpro White varnish), self-assembling peptide (Curodont™ Repair) and their combined use on WSL after orthodontic treatment.
MATERIALS AND METHODS
Thirty-two subjects, aged of 10-18 (mean age 13.91 ± 2.92) with 107 post-orthodontic WSL were included in the study. Subjects were divided into four groups as control, tricalcium phosphate (TCP) containing fluoride varnish (Clinpro White varnish) group, self-assembling P11-4 peptides (Curodont™ Repair) group and combined application of the two products. At the beginning, each subjects' caries risk profile was assessed by evaluating diet cariogenicity, plaque index, gingival bleeding index and stimulated salivary flow rate. Before the application of the remineralization agents, WSL baseline demineralization values were determined with QLF Inspektor™ Pro, laser fluorescence using DIAGNOdent and color values were measured by Vita EasyShade. Remineralization data were obtained by measuring ΔF, ΔQ, and lesion area with QLF. The aesthetic improvement after the remineralization process was evaluated with a spectrophotometer at six weeks, three and six months.
RESULTS
No statistically significant differences were found between the groups in terms of criteria determining patients' caries risk profiles, DIAGNOdent data, and plaque index scores (p > 0.05). Intra-group evaluation following remineralization revealed statistically significant increases in ΔF and ΔQ with a decrease in lesion area for the fluoride varnish group at six months, for the peptide group at three months, and for the combined application group at three and six months (p < 0.05). In inter-group comparisons, ΔF and ΔQ values were found to be statistically significant only in the fluoride group at six months compared to the other groups (p < 0.05). While the L* value decreased significantly in all groups at six months, a statistically significant difference in ΔE* values was observed only in the control group between three and six months.
CONCLUSION
Fluoride varnish with TCP showed highest remineralization at 6 months, and the remineralization was positively affected in the short term (three months) after the use of self-assembling P11-4 peptides and their combined application.
CLINICAL RELEVANCE
Remineralization obtained after single application of agents tested in six months in-vivo showed parallel results. In an attempt to trigger subsurface remineralization, the combined use of fluoride with self-assembling peptides as biomimetic remineralization agent needs further evaluation
Laparoscopic Roux-Y-gastric bypass versus laparoscopic one-anastomosis gastric bypass for obesity: clinical & metabolic results of a prospective randomized controlled trial
No full textFluid dynamics within renal cavities during endoscopic stone surgery: does the position of the flexible ureteroscope and ureteral access sheath affect the outflow rate?
No full textPURPOSE
To evaluate the impact of ureteroscope position within renal cavities as well as different locations of the tip of the ureteral access sheath (UAS) on fluid dynamics during retrograde intrarenal surgery (RIRS).
MATERIALS AND METHODS
A prospective observational clinical study was performed. Measurements with a flexible ureteroscope placed in the upper, middle and lower calyces were obtained with the tip of the UAS placed either 2 cm below the pyelo-ureteric junction (PUJ), or at the level of the iliac crest.
RESULTS
74 patients were included. The outflow rates from the middle and upper calyxes were statistically significantly higher compared to the lower calyx, both with the UAS close to the pyelo-ureteric junction and at the iliac crest. When the UAS was withdrawn and positioned at the level of the iliac crest, a significant decrease in outflow rates from the upper (40.1 ± 4.3 ml/min vs 35.8 ± 4.1 ml/min) and middle calyces (40.6 ± 4.0 ml/min vs 36.8 ± 4.6 ml/min) and an increase in the outflow from the lower calyx (28.5 ± 3.3 ml/min vs 33.7 ± 5.7 ml/min) were noted.
CONCLUSIONS
Our study showed that higher fluid outflow rates are observed from upper and middle calyces compared to lower calyx. This was true when the UAS was positioned 2 cm below the PUJ and at the iliac crest. Significant worsening of fluid dynamics from upper and middle calyces was observed when the UAS was placed distally at the level of the iliac crest. While the difference was statistically significant, the absolute change was not significant. In contrast, for lower calyces, a statistically significant improvement was documented