Tilleyhaastrup8847

PURPOSE OF REVIEW Spontaneous intracerebral hemorrhage (ICH) is common, associated with a high degree of mortality and long-term functional impairment, and remains without effective proven treatments. Surgical hematoma evacuation can reduce mass effect and decrease cytotoxic effects from blood product breakdown. However, results from large clinical trials that have examined the role of open craniotomy have not demonstrated a significant outcome benefit over medical management. We review the data on minimally invasive surgery (MIS) that is emerging as a treatment modality for spontaneous ICH. RECENT FINDINGS The use of MIS for supratentorial ICH has increased significantly in recent years and appears to be associated with decreased mortality and improved functional outcome compared with medical management. The role of MIS for posterior fossa ICH is ill-defined. Currently available MIS devices allow for stereotactic aspiration and thrombolysis, endoport-mediated evacuation, and endoscopic aspiration. Clinical series demonstrate that MIS can facilitate significant hematoma volume reduction and may be associated with less morbidity than conventional open surgical approaches. SUMMARY MIS is an appealing treatment modality for supratentorial ICH and with careful patient selection and technologic advances has the potential to improve neurologic outcomes and reduce mortality. Early and extensive hematoma evacuation are important therapeutic targets and current studies are underway that have the potential to change the management for ICH patients.PURPOSE OF REVIEW The review focuses on the evaluation and management of abdominal sepsis. RECENT FINDINGS A multitude of surgical approaches towards abdominal sepsis are practized in the world and may be associated with significant morbidity and mortality rates. Despite decades of sepsis research, no specific therapies for sepsis have emerged. see more Without specific therapies, the management of abdominal sepsis is based on the control of the infection and organ support. SUMMARY Early clinical diagnosis, adequate source control to stop ongoing contamination, appropriate antibiotic therapy dictated by patient and infection risk factors, and prompt resuscitation are the cornerstones of its management.PURPOSE OF REVIEW The purpose of this review is to provide an overview of the pathophysiology of intraabdominal hypertension/compartment syndrome and to review the recent advances in the areas of evaluation and management of this disorder. RECENT FINDINGS The incidence of intraabdominal hypertension (IAH) in intensive care units is as high as 45%, an incidence much higher than initially suspected. Despite decompressive laparotomy as a treatment, mortality in patients who developed abdominal compartment syndrome (ACS) requiring this procedure is as high as 50%. Some patients may be treated by fewer invasive methods, such as paracentesis, thereby avoiding the morbidity of laparotomy. Protective lung ventilation is key to managing the pulmonary sequalae of ACS. Point-of-care ultrasound can be used as an adjunctive decision-making tool. SUMMARY IAH is common in critically ill patients and portends a high mortality rate. Prevention and early recognition are key in minimizing adverse events.PURPOSE OF REVIEW The aim of this review is to provide an update on the pathophysiology and treatment of severe traumatic brain injury (TBI)-related complications on extracranial organs. RECENT FINDINGS Extracranial complications are common and influence the outcome from TBI. Significant improvements in outcome in a sizeable proportion of patients could potentially be accomplished by improving the ability to prevent or reverse nonneurological complications such as pneumonia, cardiac and kidney failure. Prompt recognition and treatment of systemic complications is therefore fundamental to care of this patient cohort. However, the role of extracranial pathology often has been underestimated in outcome assessment since most clinicians focus mainly on intracranial lesions and injury rather than consider the systemic effects of TBI. SUMMARY Robust evidence about pathophysiology and treatment of extracranial complications in TBI are lacking. Further studies are warranted to precisely understand and manage the multisystem response of the body after TBI.BACKGROUND Unicompartmental knee replacement (UKR) offers substantial benefits compared with total knee replacement (TKR) but is associated with higher revision rates. Data from registries suggest that revision rates for cementless UKR implants are lower than those for cemented implants. It is not known how much of this difference is due to the implant or to other factors, such as a greater proportion of high-volume surgeons using cementless implants. We aimed to determine the effect of surgeon caseload on the revision rate of matched cemented and cementless UKRs. METHODS From a group of 40,522 Oxford (Zimmer Biomet) UKR implants (30,814 cemented, 9,708 cementless) recorded in the National Joint Registry, 14,814 (7,407 cemented, 7,407 cementless) were propensity-score matched. Surgeons were categorized into 3 groups low volume ( less then 10 cases/year), medium volume (10 to less then 30 cases/year), and high volume (≥30 cases/year). The effect of caseload on the relative risk of revision was assessed with uplants was lower for surgeons in all 3 caseload groups (HR = 0.74, 0.79, 0.80, respectively). CONCLUSIONS Cementless fixation decreased the revision rate by about a quarter, whatever the surgeon caseload. Caseload had a profound effect on implant survival. Low-volume surgeons had a high revision rate with cemented or cementless fixation and therefore should consider either stopping or doing more UKR procedures. High-volume surgeons performing cementless UKR demonstrated a 10-year survival rate of 97.5%, which was similar to that reported in registries for the best-performing TKRs. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.OBJECTIVE The objective of this study was to develop a nomogrom for prediction of pathological complete response (PCR) to neoadjuvant chemotherapy in breast cancer patients. METHODS Ninety-one patients were analyzed. A total of 396 radiomics features were extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator was selected for data dimension reduction to build a radiomics signature. Finally, the nomogram was built to predict PCR. RESULTS The radiomics signature of the model that combined DCE-MRI and ADC maps showed a higher performance (area under the receiver operating characteristic curve [AUC], 0.848) than the models with DCE-MRI (AUC, 0.750) or ADC maps (AUC, 0.785) alone in the training set. The proposed model, which included combined radiomics signature, estrogen receptor, and progesterone receptor, yielded a maximum AUC of 0.837 in the testing set. CONCLUSIONS The combined radiomics features from DCE-MRI and ADC data may serve as potential predictor markers for predicting PCR.