Perioperative management of pediatric en-bloc combined heart-liver transplants: a case series review

2016 ◽  
Vol 26 (10) ◽  
pp. 976-986 ◽  
Author(s):  
Manchula Navaratnam ◽  
Ann Ng ◽  
Glyn D. Williams ◽  
Katsuhide Maeda ◽  
Julianne M. Mendoza ◽  
...  
Keyword(s):  
Perioperative Management ◽  
Case Series ◽  
Liver Transplants ◽  
En Bloc

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

scholarly journals Perioperative Management of Buprenorphine: Solving the Conundrum

Pain Medicine ◽  
2018 ◽  
Vol 20 (7) ◽  
pp. 1395-1408 ◽  
Author(s):  
Aurora Naa-Afoley Quaye ◽  
Yi Zhang
Keyword(s):  
Perioperative Management ◽  
Case Reports ◽  
Management Strategies ◽  
Case Series ◽  
Analgesic Efficacy ◽  
Published Data ◽  
Opioid Use ◽  
Mu Opioid ◽  
Periprocedural Management ◽  
Opioid Agonists

Abstract Objective There is no consensus on the optimal perioperative management of patients on buprenorphine (BUP) for opioid use disorder (OUD). This article will review the available literature on BUP and the analgesic efficacy of BUP combined with full mu-opioid agonists and discuss the conflicting management strategies in the context of acute pain and our institution’s protocol for the periprocedural management of BUP. Methods We searched published data on BUP periprocedural management from inception through March 2018 without language restrictions. Study selection included publications reporting outcomes on perioperative pain management in OUD patients maintained on BUP. Results Our search resulted in four case reports supporting periprocedural discontinuation of BUP and two case series, one secondary observational study, one prospective matched cohort study, and four retrospective cohort studies supporting periprocedural continuation of BUP. No clinical trials were identified. Conclusions Maintaining BUP perioperatively does not lead to worsened clinical outcomes. Patients can receive adequate pain control from mu-opioid agonists while maintained on BUP. Based upon available evidence, we recommend continuing BUP at a reduced dose when indicated to avoid withdrawal symptoms and to facilitate the analgesic efficacy of mu-opioid agonists administered in combination for acute postoperative pain.

Nonvascularized Toe Joint Transfers to the Hand in Young Children: Technique Revisited

Hand ◽  
2020 ◽  
pp. 155894472094824
Author(s):  
Jeffrey G. Trost ◽  
Matthew Kaufman ◽  
David T. Netscher
Keyword(s):  
Case Series ◽  
Extensor Tendon ◽  
Finger Joint ◽  
Growth Potential ◽  
Microvascular Reconstruction ◽  
Practical Consideration ◽  
En Bloc ◽  
Joint Reconstruction ◽  
Congenital Deformities ◽  
Small Joint

Background: Small joint reconstruction of the hand poses a significant challenge, especially in children where both functional motion and preservation of the epiphysis are desired. Auto-transplantation of whole joints is the only way to reconstruct a functional joint that maintains growth potential. Historically, nonvascularized toe-to-finger joint transfer has been criticized for high rates of avascular necrosis and joint dissolution, while vascularized transfers seemingly resulted in increased durability of the joint space and epiphysis. However, certain populations remain poor candidates for microvascular reconstruction, such as those with congenital deformities or sequelae from trauma or infection. In our case series, we demonstrate that a simplified nonvascularized surgical technique and careful patient selection can produce stable, functional joints. Methods: Nonvascularized toe-to-finger joint transfer was performed in 3 children between the ages of 4 and 6. Reconstructed joints included 2 proximal interphalangeal (PIP) joints and 1 metacarpophalangeal (MCP) joint. Donor grafts consisted of second toe PIP joints harvested en bloc to include the epiphysis of the middle phalanx, collateral ligaments, volar plate, and a diamond-shaped island of extensor tendon with its central slip attachment. Results: Follow-up ranged from 7 to 29 months. Each patient demonstrated functional improvements in joint motion and stability. Postoperative radiographs confirmed adequate joint alignment and persistence of the joint spaces. Epiphyseal closure was observed in 1 patient as early as 25 months postoperatively. Conclusions: Nonvascularized joint transfer should remain a practical consideration for small joint reconstruction of the hand in certain pediatric patients.

scholarly journals Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series

2019 ◽  
Vol 07 (05) ◽  
pp. E664-E671 ◽  
Author(s):  
Victoria Jimenez-Garcia ◽  
Masayoshi Yamada ◽  
Hiroaki Ikematsu ◽  
Hiroyuki Takamaru ◽  
Seiichiro Abe ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Case Series ◽  
Clinicopathological Characteristics ◽  
R0 Resection ◽  
Incomplete Resection ◽  
Colorectal Tumors ◽  
Resection Rate ◽  
Retrospective Case ◽  
En Bloc ◽  
Submucosal Dissection

Abstract Background and study aims Surgery is the standard treatment for colon tumors associated with diverticulum. Use of endoscopic submucosal dissection (ESD) to treat such tumors is controversial. The aim of this study was to assess the safety and feasibility of ESD in treating superficial colorectal tumors situated near or involving diverticulum. Patients and methods Consecutive patients from two referral centers who had colorectal tumors near or involving diverticulum treated by ESD were retrospectively studied. Clinicopathological characteristics and clinical outcomes were analyzed. Results Of the 12 patients studied, six had tumors near diverticulum and six had tumors involving diverticulum. The overall en-bloc R0 resection rate, median tumor size and procedure time were 67 %, 26.5 mm (range, 15 – 80 mm) and 110 minutes (range, 50 – 220 minutes), respectively. For tumors near diverticulum group, the en-bloc R0 resection rate was 100 % and no adverse events (AEs) or residual/recurrent tumors were observed. In contrast, for intradiverticular tumors group, the en-bloc R0 resection rate was low at 33 %, and one AE (perforation) was observed. The diverticula were ≥ 6 mm in diameter in the patients with incomplete resection. However, all but one diverticulum was unrecognized before ESD. Two residual tumors were detected at the 12-month surveillance and one required surgery. Conclusions This case series indicates that ESD is safe and feasible for treating colorectal tumors near a diverticulum and might be feasible for tumors involving a diverticulum smaller than 6 mm. Selection for smaller diverticulum size may contribute to higher en-bloc R0 resection rates.

scholarly journals High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

2019 ◽  
Vol 07 (09) ◽  
pp. E1166-E1174 ◽  
Author(s):  
Jérémie Jacques ◽  
Aurélie Charissoux ◽  
Pierre Bordillon ◽  
Romain Legros ◽  
Jérôme Rivory ◽  
...  
Keyword(s):  
Case Series ◽  
Rubber Band ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Point Of View ◽  
University Hospital ◽  
Control Group ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc

Abstract Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band. Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017. Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators. Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.

scholarly journals En bloc vertebrectomy for the treatment of spinal lesions. Five years of experience in a single institution: a case series

Clinics ◽  
2018 ◽  
Vol 73 ◽  
Author(s):  
AO Araujo ◽  
DK Narazaki ◽  
WG Teixeira ◽  
CS Ghilardi ◽  
PH Araujo ◽  
...  
Keyword(s):  
Case Series ◽  
Years Of Experience ◽  
Single Institution ◽  
En Bloc ◽  
Spinal Lesions

scholarly journals Endoscopic Transcranial and Intracranial Resection: Case Series and Design of a Perioperative Management Protocol

Skull Base ◽  
2010 ◽  
Vol 21 (01) ◽  
pp. 013-022 ◽  
Author(s):  
Evan Ransom ◽  
John Lee ◽  
John Lee ◽  
James Palmer ◽  
Alexander Chiu
Keyword(s):  
Perioperative Management ◽  
Case Series ◽  
Management Protocol

scholarly journals Improved endoscopic resection of large flat lesions and early cancers using an external additional working channel (AWC): a case series

2019 ◽  
Vol 07 (02) ◽  
pp. E298-E301 ◽  
Author(s):  
Benjamin Walter ◽  
Simone Schmidbaur ◽  
Yannick Krieger ◽  
Alexander Meining
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Resection ◽  
Case Series ◽  
En Bloc Resection ◽  
Lower Gastrointestinal Tract ◽  
En Bloc ◽  
Dual Channel ◽  
Arterial Bleeding ◽  
Flat Lesions ◽  
Bimanual Tasks

Abstract Background En-bloc resection of large, flat lesions or early stages of cancer is challenging. No bimanual tasks are possible using standard endoscopes. Dual-channel endoscopes are not available everywhere and have a small distance between the channels. Patients and methods A new external additional working channel (AWC) (Ovesco, Tuebingen, Germany) was designed and developed potentially enabling bimanual tasks. Fixed to the tip of a standard gastroscope or pediatric colonoscope, a second endoscopic tool can be inserted through the AWC and used for tissue retraction during endoscopic resection. Results In the upper and lower gastrointestinal tract, endoscopic mucosal resection (EMR) with a modified grasp-and-snare technique and endoscopic submucosal dissection (ESD) were performed successfully using the AWC in eight patients. Complications were acute arterial bleeding post-EMR in two cases treated by endoscopic clipping. Conclusions We conclude that a newly developed external additional working channel (AWC) enables endoscopic resection of large lesions in the upper and lower gastrointestinal tract. Potential benefits are its suitability for EMR and ESD, no need for a dual-channel endoscope and an adjustable distance of working channels.

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