Articles: surgery.
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Randomized Controlled Trial Multicenter Study
Improving Surgical Care and Outcomes in Older Cancer Patients Through Implementation of a Pre-Surgical Toolkit (OPTI-Surg)-Final Results of a Phase III Cluster Randomized Trial (Alliance A231601CD).
To assess the effect of a practice-level preoperative frailty screening and optimization toolkit (OPTI-Surg) on postoperative functional recovery and complications in elderly cancer patients undergoing major surgery. ⋯ Frailty assessment was successfully performed, but the OPTI-Surg intervention did not improve postoperative function nor reduce postoperative complications compared with UC. Future analysis will explore practice-level factors associated with toolkit implementation and the differences between the coaching and noncoaching arms.
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Labrune syndrome is a rare white matter disease characterized by angiomatous leukoencephalopathy, diffuse intracranial calcifications and supratentorial and infratentorial parenchymal cysts. The clinical worsening is often related to cyst expansion, and surgery may be advocated for symptomatic management in about one third of cases. However, no consensus exists on the surgical timing, the most effective procedure, and the long-term results. ⋯ Leukoencephalopathy with cerebral calcifications and cysts is a rare neurodegenerative disorder for which effective medical treatment is lacking. Surgery remains the only therapeutic option to control the disease to reduce the mass effect of growing cystic lesions. Almost half of the patients who underwent surgery required further approaches, with great concern for the associated disabilities. Several procedures have been described, with no evidence regarding which procedure is the most effective. Individual-based surgical planning must be advocated, tailoring the approach to limit side effects. Mini-invasive neuroendoscopic approaches may be considered to achieve satisfactory results.
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Anesthesia and analgesia · Oct 2024
Carboxyhemoglobin in Cardiac Surgery Patients and Its Association with Risk Factors and Biomarkers of Hemolysis.
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with hemolysis. Yet, there is no easily available and frequently measured marker to monitor this hemolysis. However, carboxyhemoglobin (CO-Hb), formed by the binding of carbon monoxide (a product of heme breakdown) to hemoglobin, may reflect such hemolysis. We hypothesized that CO-Hb might increase after cardiac surgery and show associations with operative risk factors and indirect markers for hemolysis. ⋯ CO-Hb may represent a readily obtainable and frequently measured biomarker that has a moderate association with known biomarkers of and risk factors for hemolysis in on-pump cardiac surgery patients. These findings have potential clinical implications and warrant further investigation.
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To assess the association of intraoperative hypotension with long-term survivals in older patients after major noncardiac surgery mainly for cancer. ⋯ In older patients who underwent major noncardiac surgery mainly for cancer, intraoperative hypotension was associated with worse overall, recurrence-free, and event-free survivals.
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The current research on geriatric patients with spinal chondrosarcoma is limited. This study aimed to investigate the demographics, patterns of care, and survival of geriatric patients with chondrosarcoma of the mobile spine. ⋯ Surgical resection significantly lowered the mortality risk in geriatric patients with spinal chondrosarcomas. Demographic and geographical factors significantly dictated treatment plans. Further studies are required to assess the role of radiotherapy and chemotherapy in treating these patients in the modern era.