Mild Hypothermia During Prolonged Surgery May Reduce Complications

MedicalResearch.com Interview with:

Brett A. Miles, DDS MD FACS Associate Professor of Otolaryngology Head and Neck Surgery Co-Chief Division Head and Neck Oncology Fellowship Director Head and Neck Oncologic and Microvascular Reconstructive Surgery Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York, NY 10029

Dr. Miles

Brett A. Miles, DDS MD FACS
Associate Professor of Otolaryngology Head and Neck Surgery
Co-Chief Division Head and Neck Oncology
Fellowship Director
Head and Neck Oncologic and Microvascular Reconstructive Surgery
Department of Otolaryngology Head and Neck Surgery
Icahn School of Medicine at Mount Sinai
New York, NY 10029 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The ideal core temperature for patients undergoing prolonged major head and neck surgery remains unknown. Previous data indicates the low temperatures may increase the risk of developing postoperative complications such as tissue loss, hematomas, or surgical infections.(1) Other studies have indicated that high temperatures may also influence outcomes and lead to increased complications such as bleeding.(2)

This study was a study of 519 patients who underwent major head and neck surgery at the Mount Sinai Hospital, New York, New York. The study looked at the core temperature of the patients during prolonged surgery for head and neck cancer in order to identify the optimal temperature range for these patients to prevent complications.

The study found that higher intraoperative temperatures were associated with worse outcomes in terms of tissue loss, wound complications, and infection. Our study suggests an optimal temperature range of 35.3C-37.6C. If patients were above or below that range for a significant period of time, their complications increased. Therefore maintaining this temperature range (mild hypothermia) may improve flap outcomes in this population.

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Gastric Bypass: Half of Diabetic Patients In Remission 12 Years After Surgery

MedicalResearch.com Interview with:
Ted Adams PhD
Adjunct Professor, Internal Medicine
Adjunct Associate Professor, Nutrition & Integrative Physiology
The University of Utah 

MedicalResearch.com: Why did you decide to conduct this study?

Response: The primary aim of the study was to determine the clinical outcomes in patients who underwent gastric bypass surgery.

As NIDDK/NIH continued to fund the study, the aim was extended to determining the durability) long-term outcomes) of gastric bypass surgery when compared to non-surgical, severely obese patients.

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48-Hours of Antibiotics Reduced Infection Rate After C-Section in Obese Women

MedicalResearch.com Interview with:

Dr. Carri R. Warshak, MD Associate Professor of Obstetrics & Gynecology University of  Cincinnati

Dr. Warshak

Dr. Carri R. Warshak, MD
Associate Professor of Obstetrics & Gynecology
University of  Cincinnati

MedicalResearch.com: What is the background for this study?

Response: Cesarean deliveries are the most common major surgical procedure performed in the United States.  A common complication of cesarean section is wound infections that can include infections in the skin and incision site, or infections in the uterus itself after delivery.  These complications can lead to prolonged hospitalization after delivery for antibiotics and even further surgery in severe infections.  Often these wound complications lead to delayed healing, wound opening which can sometimes take several weeks to heal. Studies have demonstrated as many as 12% of women experience a surgical site infection after delivery.

Obesity is a strong risk factor for increased surgical site infections.  Increasing maternal weight increases the risk of wound complications, with a two to five fold increase in risk, making surgical site infections and common and concerning complication of cesarean delivery in obese women.

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Which Is Better? Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

MedicalResearch.com Interview with:

Prof. Jean-Louis MAS Université Paris Descartes INSERM UMR S 894 Service de Neurologie et Unité Neurovasculaire Hôpital Sainte-Anne Paris 

Prof. Jean Louis MAS

Prof. Jean-Louis MAS
Université Paris Descartes
INSERM UMR S 894
Service de Neurologie et Unité Neurovasculaire
Hôpital Sainte-Anne
Paris 

MedicalResearch.com: What is the background for this study?

Response: Stroke is a major cause of death, disability and dementia affecting 17 million people each year worldwide. About 80% of strokes are ischemic strokes due to occlusion of a cerebral artery by a thrombus, itself the consequence of various arterial or heart diseases. In 30 to 40% of cases, no definite cause of ischemic stroke can be identified. Cryptogenic stroke is the term used to refer to these strokes of unknown etiology.

The patent foramen ovale (PFO) is a defect between the upper two heart chambers (called atria) though which a thrombus of venous origin may reach the systemic circulation and cause a stroke. This mechanism is called paradoxical embolism. Several case-control studies have shown an association between PFO and cryptogenic ischemic stroke, particularly in patients less than 60 years old, in those who have an atrial septal aneurysm (defined as an abnormal protrusion of the interatrial septum in the right or the left atrium or both) in addition to a PFO, and in those who have a PFO with a large right-to-left shunt. These findings suggested that a PFO might be responsible for stroke and that PFO closure with a device may decrease the risk of stroke recurrence. However, the causative relationship between PFO and stroke and the best strategy to prevent stroke recurrence have long been a hot topic of debate. Three previous randomized clinical trials failed to demonstrate any superiority of PFO closure over antithrombotic therapy.

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Risk Factors For Reoperation and Readmission After Parathyroidectomy Identified

MedicalResearch.com Interview with:

Raymond L. Chai, MD Assistant Professor of Otolaryngology Icahn School of Medicine at Mount Sinai.

Dr. Rai

Raymond L. Chai, MD
Assistant Professor of Otolaryngology
Icahn School of Medicine at Mount Sinai. 

MedicalResearch.com: What is the background for this study?

Response: Primary hyperparathyroidism is a common endocrine disorder affecting up to 1% of the general population. Surgical intervention is the only known durable cure for the disease. Untreated primary hyperparathyroidism can lead to number of health problems, including progressive osteoporosis and kidney stones. Although parathyroidectomy is a commonly performed surgical procedure by otolaryngologists, limited data exists regarding risk factors and rates of reoperation and readmission following surgery.

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Delaying Reconstruction Did Not Increase Postoperative Complications in Moh’s Skin Cancer Surgery

MedicalResearch.com Interview with:
Matthew Q. Miller, MD
Department of Otolaryngology–Head and Neck Surgery
University of Virginia Health System, Charlottesville 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Skin cancer is the most common type of cancer worldwide. In the United States, 3.3 million people are diagnosed with a new skin cancer annually and many of these individuals will have more than one cancer. The face is the most common place for skin cancers to develop. Mohs micrographic surgery (often referred to as Mohs surgery) is the standard of care for some skin cancers on the face. Once the cancer is removed, the skin defect is usually repaired by the Mohs surgeon but many require referral to a reconstructive surgeon.

We were intrigued by a recent publication that noted an increased risk in complications when repair of Mohs defects is delayed beyond 2 days. While most patients that will require referral for reconstruction can be predicted and scheduled accordingly in concert with the Mohs surgery, it is not infrequent that a Mohs procedure requires multiple, unexpected passes to excise the entire cancer and the patient is then left with an unexpectedly large defect requiring reconstruction. These large defects often require more OR time and planning and, therefore, reconstruction cannot be easily completed within 2 days of the Mohs procedure.

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Adherence To Guidelines Reduces Mortality & Admissions For Patients With Severe Aortic Stenosis

MedicalResearch.com Interview with:

Mario Goessl, MD, PhD, FACC, FAHA, FESC, FSCAI Director, Research and Education, Center for Valve and Structural Heart Disease Director, LAAC/Watchman™ Program Program Director, Fellowship in Advanced Adult Structural and Congenital Heart Disease Interventions and Interventional Cardiology Fellowship Minneapolis Heart Institute | Abbott Northwestern Hospital, part of Allina Health

Dr. Goessl

Mario Goessl, MD, PhD, FACC, FAHA, FESC, FSCAI
Director, Research and Education, Center for Valve and Structural Heart Disease
Director, LAAC/Watchman™ Program
Program Director, Fellowship in Advanced Adult Structural and Congenital Heart Disease Interventions and Interventional Cardiology Fellowship
Minneapolis Heart Institute | Abbott Northwestern Hospital, part of Allina Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to investigate if asymptomatic patients with severe aortic stenosis benefit clinically from adherence to current national guidelines that suggest close follow up within 6-12 months.

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DNA Analysis Identifies Subtype of Pancreatic Cancer With Good Prognosis

MedicalResearch.com Interview with:

Nancy You, MD, MHSc, FACS Department of Surgical Oncology The University of Texas MD Anderson Cancer Center Houston

Dr. You

Nancy You, MD, MHSc, FACS
Department of Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study was motivated by the emerging promise of precision medicine and the emerging evidence that immunotherapy may have phenomenal efficacy in particular molecular subtypes of cancers.  This specific molecular subtype shows deficiency in DNA mismatch repair mechanisms and therefore is thought to be more immunogenic.  DNA mismatch repair deficiency can arise from germline defects such as in the case of patients with Lynch Syndrome, an inherited cancer syndrome, or from epigenetic inactivation DNA mismatch repair genes.

Overall, pancreas cancer has seen limited success with conventional chemotherapy.  In our study, we demonstrated that there is a particular molecular subtype of pancreas cancer that is characterized by defect in DNA mismatch repair genes and by microsatelie instability that has a different prognosis than other pancreas cancers.  This subtype of pancreas cancer is suspected to also respond to immunotherapy.

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NEJM: On-Pump CABG Should Continue To Be Standard Surgical Treatment

MedicalResearch.com Interview with:

A. Laurie Shroyer, Ph.D., M.S.H.A. WOC Health Science Officer Northport VAMC Research and Development Office (151) Northport, NY 11768 Professor and Vice Chair for Research, Department of Surgery Stony Brook University, School of Medicine Stony Brook, NY

Dr. Shroyer

A. Laurie Shroyer, Ph.D., M.S.H.A.
WOC Health Science Officer
Northport VAMC
Research and Development Office (151)
Northport, NY 11768
Professor and Vice Chair for Research, Department of Surgery
Stony Brook University, School of Medicine
Stony Brook, NY 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Since the 1990’s, two different approaches have been commonly used by cardiac surgeons to perform an adult coronary artery bypass graft (CABG) procedure, these approaches have been referred to as  “on-pump” (with cardiopulmonary bypass) or “off-pump” (without cardiopulmonary bypass) procedures. The Department of Veterans Affairs (VA) Randomized On/Off Bypass Follow-up Study” (ROOBY-FS) compared the relative performance of off-pump versus on-pump approaches upon 5-year patients’ clinical outcomes including mortality and major adverse cardiovascular events.

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Repeated Breast-Conserving Surgeries Come With Significant Complications and Costs

MedicalResearch.com Interview with:

Dr. Lisa K. Jacobs MD Johns Hopkins School of Medicine Baltimore, Maryland

Dr. Jacobs

Dr. Lisa K. Jacobs MD
Johns Hopkins School of Medicine
Baltimore, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Breast preservation is the preferred treatment for many women diagnosed with breast cancer.  The most common question that a patient will ask after the surgery is, “Did you get it all?” In the ideal case, this is accomplished in a single outpatient surgery with very good cosmetic results.  In our study, Beyond the Margins-Economic Costs and Complications Associated with Repeated Breast-Conserving Surgeries we evaluated the detrimental effects of an unsuccessful initial surgery due to positive surgical margins. Using private insurance claims data, we found that 16% of patients planning breast preservation required a second breast-conserving surgery and an additional 7% converted to mastectomy.  Of those patients that required additional surgery there was a 56% ($16,072) increase in cost and a 48% increase in complications.  Those complications include infection, hematoma, seroma, and fat necrosis.  This study demonstrates that repeated surgery has not only cosmetic consequences, but also has financial implications and increased risk.

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