Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 21
Filter
1.
Lancet Respir Med ; 9(5): 487-497, 2021 05.
Article in English | MEDLINE | ID: covidwho-1537196

ABSTRACT

BACKGROUND: Lung transplantation is a life-saving treatment for patients with end-stage lung disease; however, it is infrequently considered for patients with acute respiratory distress syndrome (ARDS) attributable to infectious causes. We aimed to describe the course of disease and early post-transplantation outcomes in critically ill patients with COVID-19 who failed to show lung recovery despite optimal medical management and were deemed to be at imminent risk of dying due to pulmonary complications. METHODS: We established a multi-institutional case series that included the first consecutive transplants for severe COVID-19-associated ARDS known to us in the USA, Italy, Austria, and India. De-identified data from participating centres-including information relating to patient demographics and pre-COVID-19 characteristics, pretransplantation disease course, perioperative challenges, pathology of explanted lungs, and post-transplantation outcomes-were collected by Northwestern University (Chicago, IL, USA) and analysed. FINDINGS: Between May 1 and Sept 30, 2020, 12 patients with COVID-19-associated ARDS underwent bilateral lung transplantation at six high-volume transplant centres in the USA (eight recipients at three centres), Italy (two recipients at one centre), Austria (one recipient), and India (one recipient). The median age of recipients was 48 years (IQR 41-51); three of the 12 patients were female. Chest imaging before transplantation showed severe lung damage that did not improve despite prolonged mechanical ventilation and extracorporeal membrane oxygenation. The lung transplant procedure was technically challenging, with severe pleural adhesions, hilar lymphadenopathy, and increased intraoperative transfusion requirements. Pathology of the explanted lungs showed extensive, ongoing acute lung injury with features of lung fibrosis. There was no recurrence of SARS-CoV-2 in the allografts. All patients with COVID-19 could be weaned off extracorporeal support and showed short-term survival similar to that of transplant recipients without COVID-19. INTERPRETATION: The findings from our report show that lung transplantation is the only option for survival in some patients with severe, unresolving COVID-19-associated ARDS, and that the procedure can be done successfully, with good early post-transplantation outcomes, in carefully selected patients. FUNDING: National Institutes of Health. VIDEO ABSTRACT.


Subject(s)
COVID-19 , Critical Illness/therapy , Lung Transplantation/methods , Lung , Respiratory Distress Syndrome , Blood Transfusion/methods , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/surgery , Critical Care/methods , Extracorporeal Membrane Oxygenation/methods , Female , Humans , Intraoperative Care/methods , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pulmonary Fibrosis/etiology , Pulmonary Fibrosis/pathology , Respiration, Artificial/methods , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/surgery , SARS-CoV-2/pathogenicity
2.
World J Surg Oncol ; 18(1): 264, 2020 Oct 08.
Article in English | MEDLINE | ID: covidwho-1455977

ABSTRACT

BACKGROUND: Approximately 30% of patients with colorectal cancer develop colorectal liver metastases (CRLM). CRLM that become undetectable by imaging after chemotherapy are called disappearing liver metastases (DLM). But a DLM is not necessarily equal to cure. An increasing incidence of patients with DLM provides surgeons with a difficult dilemma: to resect or to not resect the original sites of DLM? The aim of this review was to investigate to what extent a DLM equates a complete response (CR) and to compare outcomes. METHODS: This review was conducted in accordance with the PRISMA guidelines and registered in Prospero (registration number CRD42017070441). Literature search was made in the PubMed and Embase databases. During the process of writing, PubMed was repeatedly searched and reference lists of included studies were screened for additional studies of interest for this review. Results were independently screened by two authors with the Covidence platform. Studies eligible for inclusion were those reporting outcomes of DLM in adult patients undergoing surgery following chemotherapy. RESULTS: Fifteen studies were included with a total of 2955 patients with CRLM. They had 4742 CRLM altogether. Post-chemotherapy, patients presented with 1561 DLM. Patients with one or more DLM ranged from 7 to 48% (median 19%). Median DLM per patient was 3.4 (range 0.4-5.6). Patients were predominantly evaluated by contrast-enhanced computed tomography (CE-CT) before and after chemotherapy, with some exceptions and with addition of magnetic resonance imaging (MRI) in some studies. Intraoperative ultrasound (IOUS) was universally performed in all but two studies. If a DLM remained undetectable by IOUS, this DLM represented a CR in 24-96% (median 77.5%). Further, if a DLM on preoperative CE-CT remained undetectable by additional workup with MRI and CE-IOUS, this DLM was equal to a CR in 75-94% (median 89%). Patients with resected DLM had a longer disease-free survival compared to patients with DLM left in situ but statistically significant differences in overall survival could not be found. CONCLUSION: Combination of CE-CT, MRI, and IOUS showed promising results in accurately identifying DLM with CR. This suggests that leaving DLM in situ could be an alternative to surgical resection when a DLM remains undetectable by MRI and IOUS.


Subject(s)
Colorectal Neoplasms , Liver Neoplasms , Adult , Colorectal Neoplasms/diagnostic imaging , Contrast Media , Hepatectomy , Humans , Intraoperative Care , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/surgery , Magnetic Resonance Imaging , Prognosis
3.
Surg Endosc ; 35(5): 2126-2133, 2021 05.
Article in English | MEDLINE | ID: covidwho-1453741

ABSTRACT

BACKGROUND: Insufficient coverage of the area of a possible groin hernia is an important risk factor in hernia recurrence. To prevent recurrence, it is important to use the appropriate mesh size based on the size of the myopectineal orifice (MPO), which is the weak area of the abdominal wall where inguinal hernias occur. We aimed to estimate the appropriate mesh size for groin hernias by investigating MPO size. METHODS: Four hundred and six patients underwent groin hernia repair using a totally extraperitoneal (TEP) approach at the Zeze Hospital between July 2009 and December 2017. We investigated patients' backgrounds, MPO components dimensions, and hernia recurrence, and evaluated the appropriate mesh size. RESULTS: The 359 male and 47 female patients had an average age of 63 ± 15 years. In 171, 147, and 88 cases, hernias were localized to the right, left, and bilaterally, respectively. The number of lateral, medial, femoral, and combined hernias was 317, 124, 11, and 42, respectively. The 95th percentile for the horizontal and vertical lengths in cases of hernia orifice ≥ 3 cm were 9.6 cm and 7.0 cm, respectively, while it was 9.2 cm and 6.4 cm in cases of hernia orifice < 3 cm. We added 2 cm and 3 cm to the 95th percentile for the length and width of the MPO, resulting in 13.2 × 10.4 cm and 15.6 × 13.0 cm in cases with hernia orifice < 3 cm and ≥ 3 cm, respectively. Relapse after TEP occurred in 1 patient (0.2%). CONCLUSION: The appropriate mesh size for TEP repair, derived from intraoperative MPO measurements, was estimated as 13.2 × 10.4 cm and 15.6 × 13.0 cm when the hernia orifice was < 3 cm and ≥ 3 cm, respectively. Using appropriate mesh sizes based on MPO measurement may reduce groin hernia recurrence after TEP.


Subject(s)
Hernia, Inguinal/surgery , Herniorrhaphy/instrumentation , Herniorrhaphy/methods , Surgical Mesh , Aged , Female , Groin/surgery , Hernia, Inguinal/etiology , Humans , Intraoperative Care , Male , Middle Aged , Recurrence , Retrospective Studies
5.
PLoS One ; 16(3): e0247282, 2021.
Article in English | MEDLINE | ID: covidwho-1127785

ABSTRACT

Intra-operative autologous blood donation is a blood conservation technique with limited evidence. We evaluated the association between intra-operative autologous blood donation and decrease in peri-operative transfusion in cardiovascular surgery based on evidence from a Japanese administrative database. We extracted the data of patients who had undergone cardiovascular surgery from the Diagnosis Procedure Combination database in Japan (2016-2019). Based on the surgery type, we examined the association of intra-operative autologous blood donation with the transfusion rate and amount of blood used in cardiac and aortic surgeries using multilevel propensity score matching. We enrolled 32,433 and 4,267 patients who underwent cardiac and aortic surgeries and received 5.0% and 6.7% intra-operative autologous blood donation with mean volumes of 557.68 mL and 616.96 mL, respectively. The red blood cell transfusion rates of the control and intra-operative autologous blood donation groups were 60.6% and 38.4%, respectively, in the cardiac surgery cohort (p < .001) and 91.4%, and 83.8%, respectively, in the aortic surgery cohort (p = .037). The transfusion amounts for the control and intra-operative autologous blood donation groups were 5.9 and 3.5 units of red blood cells, respectively, for cardiac surgery patients (p < .001) and 11.9 and 7.9 units, respectively, for aortic surgery patients (p < .001). Intra-operative autologous blood donation could reduce the transfusion rate or amount of red blood cells and fresh frozen plasma for patients undergoing index cardiovascular surgery and could be an effective blood transfusion strategy in cardiovascular surgery for Japanese patients.


Subject(s)
Blood Donors/statistics & numerical data , Blood Transfusion, Autologous/statistics & numerical data , Cardiovascular Diseases/surgery , Adult , Aged , Aged, 80 and over , Erythrocyte Transfusion , Female , Humans , Intraoperative Care , Japan , Male , Middle Aged , Multilevel Analysis , Propensity Score , Retrospective Studies , Young Adult
6.
Pathologica ; 112(4): 174-177, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1022379

ABSTRACT

Up to now, Italy is one of the European centers with the most active Coronavirus cases with 233,836 positive cases and 33,601 total deaths as of June 3rd. During this pandemic and dramatic emergency, Italian hospitals had also to face neoplastic pathologies, that still afflict the Italian population, requiring urgent surgical and oncological treatment. In our Cancer Center Hospital, the high volume of surgical procedures have demanded an equally high volume of intraoperative pathological examinations, but also posed an additional major challenge for the safety of the staff involved. The current commentary reports our experience in the past two months (since March 9th) for a total of 1271 frozen exams from 893 suspect COVID-19 patients (31 confirmed).


Subject(s)
COVID-19 , Containment of Biohazards/standards , Intraoperative Care/standards , Pandemics , Pathology/standards , COVID-19/epidemiology , Humans , Intraoperative Care/statistics & numerical data , Italy/epidemiology , Middle Aged , Pathology/statistics & numerical data
7.
Minerva Anestesiol ; 87(5): 604-612, 2021 05.
Article in English | MEDLINE | ID: covidwho-983870

ABSTRACT

A novel Coronavirus was identified in late 2019 as the cause of COVID-19 disease which is highly contagious. SARS-CoV-2 is a single-stranded RNA, enveloped virus from the beta Coronavirus family. Intraoperative management of patients with COVID-19 is a high-risk procedure. An international attention has raised to develop recommendations for the management strategies. This review article was designed to synthesize the existing evidence and experience related to intraoperative management of COVID-19. This review provides a summary of clinical guidance and addresses six domains: principles of intraoperative monitoring, airway management and related difficulties, ventilation, type of anesthesia, medications and side effects, and intraoperative fluid management.


Subject(s)
COVID-19/complications , Operating Rooms , Airway Management , Anesthesia , Fluid Therapy , Humans , Infection Control , Intraoperative Care , Pandemics
8.
Korean J Anesthesiol ; 74(2): 158-164, 2021 04.
Article in English | MEDLINE | ID: covidwho-926403

ABSTRACT

BACKGROUND: The aerosol box was rapidly developed and disseminated to minimize viral exposure during aerosolizing procedures during the COVID-19 pandemic, yet users may not understand how to use and clean the device. This could potentially lead to increased viral exposure to subsequent patients and practitioners. We evaluated intraoperative contamination and aerosol box decontamination and the impact of a preoperative educational visual aid. METHODS: Using a double-blinded randomized design, forty-four anesthesiology trainees and faculty completed a simulated anesthetic case using an aerosol box contaminated with a fluorescent marker; half of the subjects received a visual aid prior to the simulation. Intraoperative contamination was evaluated at 10 standardized locations using an ultraviolet (UV) light. Next, subjects were instructed to clean the aerosol box for use on the next patient. Following cleaning, the box was evaluated for decontamination using an UV light. RESULTS: Median total contamination score was significantly reduced in the experimental group (5.0 vs. 10.0, P < 0.001). The aerosol box was completely cleaned by 36.4% of subjects in the experimental group compared to 4.5% in the control group (P = 0.009). CONCLUSIONS: The use of a visual aid significantly decreased intraoperative contamination and improved box cleaning. Despite these findings, a potentially clinically significant amount of viral exposure may exist. Thorough evaluation of the risks and benefits of the aerosol box should be completed prior to use. If an aerosol box is used, a visual aid should be considered to remind practitioners how to best use and clean the box.


Subject(s)
Anesthesiology/education , Audiovisual Aids , COVID-19/prevention & control , Intraoperative Care/methods , Intubation, Intratracheal/instrumentation , Personal Protective Equipment , Aerosols , Double-Blind Method , Humans , SARS-CoV-2
9.
JCO Glob Oncol ; 6: 1696-1703, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-914174

ABSTRACT

PURPOSE: There is a shortage of radiation therapy service centers in low- to middle-income countries. TARGIT-intraoperative radiation therapy (IORT) may offer a viable alternative to improve radiation treatment efficiency and alleviate hospital patient loads. The Breast Care Unit in Johannesburg became the first facility in Africa to offer TARGIT-IORT, and the purpose of this study was to present a retrospective review of patients receiving IORT at this center between November 2017 and May 2020. PATIENTS AND METHODS: Patient selection criteria were based mainly on the latest American Society of Radiation Oncology guidelines. Selection criteria included early-stage breast carcinoma (luminal A) and luminal B with negative upfront sentinel lymph node biopsy that negated external-beam radiation therapy (EBRT). Patient characteristics, reasons for choosing IORT, histology, and use of oncoplastic surgery that resulted in complications were recorded. RESULTS: One hundred seven patients successfully received IORT/TARGIT-IORT. Mean age was 60.8 years (standard deviation, 9.3 years). A total of 73.8% of patients presented with luminal A, 15.0% with luminal B, and 5.6% with triple-negative cancer. One patient who presented with locally advanced breast cancer (T4N2) opted for IORT as a boost in addition to planned EBRT. Eighty-seven patients underwent wide local excision (WLE) with mastopexy, and 12 underwent WLE with parenchymal. Primary reasons for selecting IORT/TARGIT-IORT were distance from the hospital (43.9%), choice (40.2%), and age (10.3%). CONCLUSION: This retrospective study of IORT/TARGIT-IORT performed in Africa confirms its viability, with low complication rates and no detrimental effects with breast conservation, resulting in positive acceptance and the potential to reduce Oncology Center patient loads. Limitations of the study include the fact that only short-term data on local recurrence were available. Health and socioeconomic value models must still be addressed in the African setting.


Subject(s)
Breast Neoplasms/radiotherapy , COVID-19/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Pandemics , Adult , Breast Neoplasms/complications , Breast Neoplasms/surgery , Breast Neoplasms/virology , COVID-19/complications , COVID-19/surgery , COVID-19/virology , Female , Humans , Intraoperative Care , Mastectomy, Segmental , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/virology , Patient Selection , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , SARS-CoV-2/pathogenicity , South Africa/epidemiology
10.
Plast Reconstr Surg ; 146(2): 248e-250e, 2020 08.
Article in English | MEDLINE | ID: covidwho-703566
13.
A A Pract ; 14(7): e01235, 2020 May.
Article in English | MEDLINE | ID: covidwho-593778

ABSTRACT

Patients with coronavirus disease 2019 (COVID-19) with variable clinical presentations are encountered in the perioperative setting. While some have already been diagnosed and are symptomatic, others have undiagnosed, asymptomatic COVID-19. The latter group poses the greatest risk of transmission. Given limited capacities in most health care systems, diagnostic testing is mainly performed in symptomatic patients or those with relevant exposure. We report an intraoperative diagnosis of COVID-19 in an asymptomatic patient, prompted by clinical signs. To control a pandemic such as COVID-19, a high index of suspicion is pivotal when caring for asymptomatic patients in the perioperative setting.


Subject(s)
Asymptomatic Infections , Coronavirus Infections/diagnosis , Homeless Persons , Intraoperative Care , Mastectomy , Pneumonia, Viral/diagnosis , Airway Extubation/methods , Asthma/complications , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/complications , Female , Humans , Hypertension/complications , Hypoxia , Middle Aged , Obesity, Morbid/complications , Pandemics , Pneumonia, Viral/complications , Polymerase Chain Reaction , Positive-Pressure Respiration , Respiration, Artificial/methods , SARS-CoV-2
14.
Int J Surg ; 79: 168-179, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-547328

ABSTRACT

The Coronavirus (COVID-19) pandemic has resulted in over 4.5 million confirmed cases and over 300,000 deaths. The impact of COVID-19 on surgical practice is widespread, ranging from workforce and staffing issues, procedural prioritisation, viral transmission risk intraoperatively, changes to perioperative practice and ways of working alongside the impact on surgical education and training. Whilst there has been a growing literature base describing the early clinical course of COVID-19 and on aspects of critical care related to treating these patients, there has been a dearth of evidence on how this pandemic will affect surgical practice. This paper seeks to review the current evidence and offers recommendations for changes to surgical practice to minimise the effect of the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Pandemics , Patient Care Planning/organization & administration , Pneumonia, Viral/epidemiology , Surgical Procedures, Operative , Betacoronavirus , COVID-19 , Elective Surgical Procedures , Humans , Intraoperative Care , Medical Staff, Hospital , SARS-CoV-2 , Telemedicine/organization & administration , Triage
16.
Int J Obstet Anesth ; 43: 1-8, 2020 08.
Article in English | MEDLINE | ID: covidwho-358204

ABSTRACT

SARS-CoV-2 is a novel coronavirus causing a global pandemic of a severe respiratory illness known as COVID-19. To date, globally, over 30,000 people have died from this emerging disease. As clinicians and healthcare systems around the world are rapidly adapting to manage patients with COVID-19, limited data are emerging from different patient populations to support best-practice and improve outcomes. In this review, we present a summary of emerging data in the obstetric population and offer obstetric and anaesthetic clinicians around the world a set of evidence-driven, practice-based recommendations for the anaesthetic management of pregnant women with suspected or confirmed COVID-19.


Subject(s)
Anesthesia, Obstetrical , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adult , Analgesia, Obstetrical , COVID-19 , Cesarean Section , Coronavirus Infections/prevention & control , Female , Humans , Intraoperative Care , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Postoperative Care , Pregnancy , SARS-CoV-2
18.
World Neurosurg ; 138: e955-e960, 2020 06.
Article in English | MEDLINE | ID: covidwho-274866

ABSTRACT

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Subject(s)
Aneurysm, Ruptured/surgery , Coronavirus Infections/diagnosis , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intracranial Aneurysm/surgery , Neurosurgical Procedures/methods , Pneumonia, Viral/diagnosis , Subarachnoid Hemorrhage/surgery , Air Filters , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Betacoronavirus , COVID-19 , COVID-19 Testing , China , Clinical Laboratory Techniques , Computed Tomography Angiography , Coronavirus Infections/complications , Craniotomy/methods , Drainage , Emergencies , Hematoma/complications , Hematoma/diagnostic imaging , Hematoma/surgery , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Intracranial Pressure , Intraoperative Care , Lung/diagnostic imaging , Monitoring, Physiologic , Operating Rooms , Pandemics , Perioperative Care , Personal Protective Equipment , Pneumonia, Viral/complications , Practice Guidelines as Topic , SARS-CoV-2 , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed , United States
20.
Surg Infect (Larchmt) ; 21(4): 301-308, 2020 May.
Article in English | MEDLINE | ID: covidwho-88662

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Elective Surgical Procedures/standards , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Perioperative Care/standards , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Adult , Aerosols/adverse effects , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Cross Infection/etiology , Cross Infection/prevention & control , Cross Infection/virology , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/methods , Health Facilities/standards , Humans , Infection Control/methods , Intraoperative Care/methods , Intraoperative Care/standards , Intubation, Intratracheal/adverse effects , Patient Safety/standards , Perioperative Care/methods , Pneumonia, Viral/complications , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL