Is laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumor at the esophagogastric junction safe?

a.lsfakia shared this article with you from Inoreader Is laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumor at the esophagogastric junction safe? Via Asian Journal of Endoscopic Surgery Abstract Introduction With technique improvements, indications for laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumor (SET) are gradually expanding for tumors technically difficult to resect. However, surgical outcomes of LECS, including for esophagogastric junction (EGJ) tumors requiring advanced skills, remain unknown. Methods We reviewed patients in whom LECS had initially been attempted for gastric SET at the Cancer Institute Hospital in Tokyo from June 2006 to May 2018. Indications for LECS at the EGJ have gradually expanded during the study period to include tumors with esophageal invasion up to 2 cm, or less than half the EJG circumference, preoperatively. Surgical outcomes and risk factors for conversion to other procedures were investigated. Results Twenty (9.3%) of the 214 total patients had EGJ tumors. Four patients (20%) with EGJ tumors developed postoperative complications (Clavien‐Dindo grade ≥ II). Among 12 patients in whom LECS could be completed for EGJ tumors, only one non‐serious complication occurred. Eight patients required conversion to another operation for EGJ tumors (two laparotomy, six proximal gastrectomy). Among conversion cases with EGJ tumors, anastomotic leakage occurred in both patients undergoing laparotomy after LECS, necessitating additional defect closure. There was only one non‐serious complication in six proximal gastrectomy patients. On multivariate analysis, EGJ tumor was an independent risk factor for conversion to another operation. Conclusion LECS at the EGJ may be a risk factor for conversion operation, and when performing LECS at the EGJ is difficult, conversion to proximal gastrectomy, which can be performed safely, should be considered. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Causes of peritoneal injury during laparoscopic totally extraperitoneal inguinal hernia repair and methods of repair

a.lsfakia shared this article with you from Inoreader Causes of peritoneal injury during laparoscopic totally extraperitoneal inguinal hernia repair and methods of repair Via Asian Journal of Endoscopic Surgery Abstract Introduction Peritoneal injury during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is an intraoperative complication that affects accomplishment. We retrospectively examined the causes of peritoneal injury and methods of TEP repair. Methods This study examined 58 patients with inguinal hernia (43 unilateral, 15 bilateral) who had undergone TEP repair; all procedures were performed by the same surgeon. The incidence of peritoneal injury, clinical characteristics that could have influenced peritoneal injury, and management of the injury were analyzed. Results Peritoneal injury was noted in 16 inguinal hernias (21.9%, 16 /73). Injury occurred more frequently in right‐sided hernias than in left‐sided hernias (31.6% vs 11.4%, P = .049). No other factors were related to injury. Peritoneal injury occurred due to anatomical misrecognition in five hernias (31.3%, 5/16) and unintentional dissection in six hernias (37.5%, 6/16). All injuries due to unintentional dissection occurred in right‐sided hernias. The procedures used for peritoneal injury repair were endoscopic suturing for 4 hernias, pre‐tied loop ligation for 1 hernia, and ligation clips in 11 hernias. Additional techniques were required in three hernias repaired by endoscopic suturing (75% 3/4). After introduction of the ligation clips, endoscopic suturing was discontinued, and no additional techniques were needed. Conclusion Peritoneal injury more frequently occurred in right‐sided inguinal hernia than in left‐sided inguinal hernia during TEP repair. The common reasons for peritoneal injury were anatomical misrecognition and unintentional dissection. Repair using ligation clips is the best option for peritoneal injuries that occur during TEP repair. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Finite element method for nerve root decompression in minimally invasive endoscopic spinal surgery

a.lsfakia shared this article with you from Inoreader Finite element method for nerve root decompression in minimally invasive endoscopic spinal surgery Via Asian Journal of Endoscopic Surgery Abstract Introduction Diagnosis is the key to improving spinal surgery outcomes. Improvements in the diagnosis of radiculopathy have created new indications for full‐endoscopic spine surgery. We assessed the finite element method (FEM) to visualize and digitize lesions not detected by conventional diagnostic imaging. Methods We used FEM in two patients: a lumbar patient and a cervical patient. The lumbar patient was a 67‐year‐old woman with a history of rheumatoid arthritis; she also had osteoporosis and pulmonary fibrosis. She had left L3 radiculopathy due to an L3 vertebral fracture. The cervical patient was a 61‐year‐old woman with left C6 radiculopathy due to C5‐C6 disc herniation. We performed full endoscopic foraminotomy per the patients's request. Based on preoperative and postoperative CT Digital Imaging and Communications in Medicine data of 0.5‐mm slices, 3‐D imaging data were reproduced, and kinetic simulation of FEM was performed. Results Postoperatively, both patients' radiculopathy disappeared, improving their activities of daily living and enabling them to walk and work. Also, the total contact area and maximum contact pressure of the nerve tissue decreased from 30% to 80% and from 33% to 67%, respectively. Conclusions A new method for perioperative evaluation and simulation, FEM can be to visualize and digitize the conditions of the lesion causing radiculopathy. FEM that can overcome both time and economic constraints in routine clinical practice is needed. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Comparison of Conventionally Versus Digitally Fabricated Denture Outcomes in a University Dental Clinic

a.lsfakia shared this article with you from Inoreader A Comparison of Conventionally Versus Digitally Fabricated Denture Outcomes in a University Dental Clinic Via Journal of Prosthodontics Abstract Purpose The purpose of this retrospective, cross‐sectional study is to evaluate if there is a difference in number of visits (including fabrication and postoperative) and remake rate when comparing conventionally fabricated and digitally fabricated complete dentures by dental students in a predoctoral student dental clinic. Materials and methods This two‐year retrospective cross‐sectional study consisted of a chart review for patients receiving maxillary and/or mandibular complete dentures between 2017 and 2019 (n = 314) at the UNC Adams School of Dentistry predoctoral student clinic. No control group was determined for this study. Data were extracted for 242 conventional dentures and 39 digital dentures. Objective treatment outcomes were obtained for each included denture: the number of patient appointments from preliminary impressions to denture placement, the number of postoperative visits, any complications noted, and any need for remakes. Fisher's Exact Test and Cochran‐Mantel‐Haenszel analysis were completed with statistical significance set at p < 0.05. Results For the number of visits from preliminary impression to placement, 50% of conventionally fabricated dentures had 6 or more visits, while only 5% of digitally fabricated dentures had 6 or more visits. This difference for the number of patient visits was statistically significant (p < 0.05). Additionally, conventionally fabricated dentures required an average of 2‐3 postoperative visits, whereas digitally fabricated dentures required 1‐2 postoperative visits. This difference was also statistically significant (p < 0.05). For the number of dentures requiring remake, there was no statistical difference (p = 0.1904). Conclusions When comparing conventionally fabricated and digitally fabricated dentures in the predoctoral clinic, the digitally fabricated dentures required fewer patient appointments from start to finish, and fewer postoperative appointments than conventionally fabricated dentures. Fewer visits may be an important consideration for patients, especially those with limited access to care. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A rare case of colorectal traditional serrated adenoma mimicking a subepithelial lesion

a.lsfakia shared this article with you from Inoreader A rare case of colorectal traditional serrated adenoma mimicking a subepithelial lesion Via Digestive Endoscopy Abstract Traditional serrated adenoma (TSA) constitutes an uncommon serrated polyp that could be a precursor to colorectal cancer via the serrated pathway.1 TSAs within the sigmoid colon or rectum often have a reddish hue with protruded morphology and villous structure that has a pinecone‐like or coral‐shaped appearance. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association among serum and salivary A. actinomycetemcomitans specific immunoglobulin antibodies and periodontitis

a.lsfakia shared this article with you from Inoreader Association among serum and salivary A. actinomycetemcomitans specific immunoglobulin antibodies and periodontitis Via Latest Results for BMC Oral Health Abstract Background The aim of this study was to assess the association between serum and salivary Immunoglobulin (Ig) Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) specific antibodies in healthy controls (HC) and periodontitis (PT) patients. Furthermore, the objectives were to determine whether PT influenced serum A. actinomycetemcomitans specific antibodies and whether serum or salivary antibodies against A. actinomycetemcomitans IgG were mediated by serum high-sensitivity c-reactive protein (hs-CRP). Methods Fifty-three patients with periodontitis and 48 HC were enrolled in the present study. Patients were regularly examined and characterized by clinical, salivary and blood samples analyses. A. actinomycetemcomitans IgA and IgG antibodies and hs-CRP were evaluated using a commercially available kit. The Spearman Correlation Test and Jonckheere-Terpstra Test were applied in order to assess the interdependence between serum A. actinomycetemcomitans IgG antibodies and clinical periodontal parameters. To evaluate the dependence of the serum and salivary A. actinomycetemcomitans IgG levels from possible confounders, univariate and multivariable linear regression analyses were performed. Results Compared to HC, patients with PT had significantly higher IgA [serum: PT, 1.89 (1.2–2.2) EU vs HC, 1.37 (0.9–1.8) EU (p = 0.022); saliva: PT, 1.67 (1.4–2.1) EU vs HC, 1.42 (0.9–1.6) EU (p = 0.019)] and A. actinomycetemcomitans IgG levels [serum: PT, 2.96 (2.1–3.7) EU vs HC, 2.18 (1.8–2.1) EU (p < 0.001); saliva, PT, 2.19 (1.8–2.5) EU vs HC, 1.84 (1.4–2) EU (p = 0.028)]. In PT patients, serum A. actinomycetemcomitans IgG were associated with a proportional extent of PT and tooth loss (P-trend value< 0.001). The univariate regression analysis demonstrated that PT (p = 0.013) and high hs-CRP (p < 0.001) had a significant negative effect on serum and salivary A. actinomycetemcomitans IgG levels. The multivariate regression analysis showed that PT (p = 0.033), hs-CRP (p = 0.014) and BMI (p = 0.01 7) were significant negative predictors of serum A. actinomycetemcomitans IgG while hs-CRP (p < 0.001) and BMI (P = 0.025) were significant negative predictors of salivary A. actinomycetemcomitans IgG. Conclusions PT patients presented a significantly higher serum and salivary A. actinomycetemcomitans IgA and IgG compared to HC. There was a significant increase in serum A. actinomycetemcomitans IgG when patients presented a progressive extent of PT. Moreover, PT and hs-CRP were significant negative predictors of increased salivary and serum A. actinomycetemcomitans IgG levels. Trial registration The study was retrospectively registered at clinicaltrials.gov (NCT04417322). View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Microscopic Colitis Is Not an Independent Risk Factor for Low Bone Density

a.lsfakia shared this article with you from Inoreader Microscopic Colitis Is Not an Independent Risk Factor for Low Bone Density Via Latest Results for Digestive Diseases and Sciences Abstract Background Microscopic colitis (MC) is a subtype of inflammatory bowel disease (IBD) with overlapping risk factors for low bone density (LBD). While LBD is a known complication of IBD, its association with MC is not well-established. Aims Assess the prevalence of LBD in MC compared to control populations, and evaluate if MC predicts LBD when controlling for confounders. Methods Retrospective, observational case control study of adult patients with pathologically confirmed MC from 2005 to 2015. Bone density measurements were abstracted from dual-energy X-ray absorptiometry (DEXA) reports, and bone density was classified using T-score: normal (T ≥ − 1.0), osteopenia (− 1.0 > T > -2.5) or osteoporosis (T ≤ − 2.5). Demographics, disease, medication history and LBD risk factors were obtained from chart review. Prevalence of LBD was compared to national and local controls. A matched control cohort to MC patients without prior diagnosis of LBD was analyzed with logistic regression to assess the relationship of MC to LBD. Results One hundred and eighteen patients with MC were identified. Osteopenia in women with MC was more prevalent compared to national controls (67% vs. 49%, p = 0.0004), and LBD was more prevalent in MC patients compared to local controls (82% vs. 55%, p < 0.0001). In MC patients without prior diagnosis of LBD matched to controls, there was a higher prevalence of osteopenia (53.2% vs. 36.7%, p = 0.04). However, after controlling for confounders, MC was not associated with LBD (OR 0.83, 95% CI 0.22, 3.16, p = 0.8). Conclusions While LBD was more prevalent in MC patients compared to control populations, with adjustment for key confounders (including BMI, steroids, smoking, vitamin D and calcium use), MC was not an independent predictor of LBD. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.