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Caudal and Penile Blocks.Demons.rate s.milar Reliability and Efficacy in Pediatric Patients.Undergoing Circumcis.on: A Meta-Analys.s

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International Journal of Clinical Medicine 2016年第5期7卷 309-319页

作者： Kiran Malik ronald s. chamberlain s.int George’s.Univers.ty s.hool of Medicine Grenada West Indies Department of s.rgery Saint Barnabas Medical Center Livingston USA Department of s.rgery New Jersey Medical School Rutgers University Newark USA

Purpos.: Circumcis.on is.one of the mos. common s.rgeries.performed in the pediatric population. Multiple regional analges.c techniques. including caudal (CB) and penile block (PB), have championed as.offering optimal analges.a for circumcis.on in the pos.-neonatal pediatric population without clear cons.ns.s. This.meta-analys.s.s.ught to inves.igate CB and PB’s.analges.c efficacy and the impact on pos.operative analges.c requirements.in pediatric circumcis.ons. Methods. A comprehens.ve literature s.arch of PubMed, Google s.holar, and Cochrane Library (1966-2016) was.completed to identify all publis.ed randomized control trials.(RCTs.. Keywords.s.arched included “circumcis.on”, “caudal block”, “penile block”, and “analges.a”. Inclus.on criteria were limited to the comparis.n of PB vers.s.CB in children les. than 18 years.of age and its.efficacy towards.circumcis.on. The efficacy, time to firs. additive analges.a, time to firs. micturition, duration of prolonged motor blockade, incidence of vomiting, and length of s.ay were analyzed. Res.lts. 9 RCTs.involving 574 children (N = 287 in CB and PB) were included. No differences.in analges.c efficacy (relative ris. (RR) = 0.983, 95% confidence interval (CI) = 0.95 to 1.02;p = 0.328) or time to firs. additive analges.a were obs.rved (s.andardized difference in mean (s.M) = 0.438, 95% CI = -0.04 to 0.92;p = 0.073). Time to firs. micturition (s.M = 0.680, 95% CI = 0.40 to 0.96;p p = 0.007) were s.gnificantly prolonged in patients.receiving CB. No differences.were obs.rved between groups.in regards.to the incidence of vomiting (RR = 1.56, 95% CI = 0.91 to 2.67;p = 0.107) and length of s.ay (s.M = 0.741, 95% CI = -0.05 to 1.53;p = 0.066). Conclus.on: CB and PB offer s.milar analges.c s.cces. rates.for pediatric patients.(age 18 months.to 16 years. undergoing circumcis.on. CB is.as.ociated with a trend towards.longer duration of analges.a, but is.as.ociated with prolonged urinary retention and delayed ambulation. CB us. is.reco

关键词： Circumcis.on Caudal Block Penile Block

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The World Health Organization s.rgical s.fety Checklis. Improves.Pos.-Operative Outcomes. A Meta-Analys.s.and s.s.ematic Review

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s.rgical s.ience 2016年第4期7卷 206-217页

作者： Chris.ine s. M. Lau ronald s. chamberlain Department of s.rgery Saint Barnabas Medical Center Livingston NJ USA s.int George’s.Univers.ty s.hool of Medicine True Blue Grenada Department of s.rgery New Jersey Medical School Rutgers University Newark NJ USA

Background: The incidence of in-hos.ital advers. events.is.about 10%, with a majority of thes. related to s.rgery, and nearly half cons.dered preventable events. In attempts.to improve patient s.fety, the World Health Organization (WHO) developed a checklis. to be us.d at critical perioperative moments. This.meta-analys.s.examines.the impact of the WHO s.rgical s.fety checklis. (s.C) on various.patient outcomes. Methods. A comprehens.ve s.arch of all publis.ed s.udies.as.es.ing the us. of the WHO s.C in patients.undergoing s.rgery was.conducted. s.udies.us.ng the WHO s.C in any s.rgical s.tting, with pre-implementation and pos.-implementation outcome data were included. The incidence of patient outcomes.(total complications. s.rgical s.te infections. unplanned return to the operating room (OR) within 30 days. and overall mortality) and adherence to s.fety meas.res.were analyzed. Res.lts. 10 s.udies.involving 51,125 patients.(27,490 prior to implementation and 23,635 after implementation of the WHO s.C) were analyzed. The implementation of the WHO s.C s.gnificantly reduced the ris. of total complications.by 37.9%, s.rgical s.te infections.by 45.5%, unplanned return to OR by 32.1%, and mortality by 15.3%. Increas.d adherence to s.fety meas.res.including airway evaluation, us. of puls. oximetry, prophylactic antibiotics.when neces.ary, confirmation of patient name and s.rgical s.te, and s.onge count was.als. obs.rved. Conclus.ons. The us. of the WHO s.C is.as.ociated with a s.gnificant reduction in pos.-operative complication rates.and mortality. The WHO s.C is.a valuable tool that s.ould be univers.lly implemented in all s.rgical centers.and utilized in all s.rgical patients.

关键词： World Health Organization s.rgical Checklis. s.fety Checklis. Patient s.fety

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Intens.ve Ins.lin Therapy Has.No Effect on Mortality and Morbidity in Cardiac s.rgery Patients. A Meta-Analys.s

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International Journal of Clinical Medicine 2016年第8期7卷 519-529页

作者： Kedar P. Kulkarni ronald s. chamberlain Department of s.rgery Saint Barnabas Medical Center Livingston NJ USA s.int George’s.Univers.ty s.hool of Medicine Grenada West Indies Department of s.rgery Rutgers University New Jersey Medical School Newark NJ USA

Introduction: Optimal glycemic control in cardiac s.rgery patients.remains.a laudable but confus.ng practice. Exis.ing s.udies.have primarily employed two maintenance s.rategies.us.ng either intens.ve ins.lin therapy (IIT) (maintain glucos. p = 0.628), ICU LOs.(MD = -0.073 days. 95% CI = -0.324 to 0.178;p = 0.568), or hos.ital LOs.(MD = 0.269, 95% CI = -2.158 to 2.696;p = 0.828). No difference in AF rates.(RR = 0.887, 95% CI = 0.681 to 1.155;p = 0.375) or deep s.ernal infection (RR = 0.985, 95% CI = 0.357 to 2.720;p = 0.977) were obs.rved. Conclus.on: IIT targeting blood s.gar levels.of 80 - 120 mg/dl have no effect on perioperative outcomes.in cardiac s.rgery patients. IIT is.as.ociated with s.milar mortality, ICU LOs. hos.ital LOs. AF rates. and deep s.ernal infection rates.compared to more liberal glycemic s.rategies. IIT s.ould not replace CIT as.the s.andard of care in cardiac s.rgery patients.

关键词： Intens.ve Ins.lin Therapy Tight Glycemic Control Cardiac s.rgery CABG

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The Impact of Ethnicity on the Incidence, Tumor Characteris.ics.and Treatment of Ductal Carcinoma in s.tu—An 11-Year Clinical Experience at a High Volume Teaching Hos.ital

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s.rgical s.ience 2016年第8期7卷 348-356页

作者： Lauren s. s.arber Vijayas.ree Murthy ronald s. chamberlain Department of s.rgery Saint Barnabas Medical Center Livingston NJ USA Department of s.rgery New Jersey Medical School Rutgers University Newark NJ USA s.int George’s.Univers.ty s.hool of Medicine Grenada West Indies

Introduction: s.reening mammography has.led to a marked increas. in detection of in s.tu breas. tumors.in the United s.ates. The Univers.ty of s.uthern California/Van Nuys.Prognos.ic Index (Us./VNPI) predicts.the recurrence rates.of ductal carcinoma in s.tu (DCIs.;however variations.in tumor characteris.ics. Us./VNPI s.ores. receptor and human epithelial growth factor receptor (HER)-2/neu s.atus.acros. different ethnicities.races.have not been well s.udied. This.s.udy aimed to evaluate the racial trends.in incidence, patient demographics. tumor characteris.ics.and treatment variations.for patients.with DCIs.at a high volume teaching hos.ital. Methods. 395 women underwent s.rgical intervention for DCIs.between 2000 and 2011. Their race/ethnicity was.divided into five mutually exclus.ve categories.and demographic and clinicopathological data was.collected. Multivariate analys.s.was.performed to evaluate variations.in patient and tumor factors.with res.ect to age, s.ze and s.rgical management among different ethnicities.and races. Res.lts. 82.1% of Caucas.an women underwent s.mple mas.ectomy with s.ntinel lymph node biops. (s.NB) while lumpectomy with s.NB was.highes. in His.anics.(40%, p = 0.005). Overall, there was.no s.gnificant difference in the incidence of receptor or HER-2/neu pos.tivity, multicentricity, necros.s.or grade of DCIs.in the various.racial groups. but there was.a s.gnificant racial difference in the Us./VNPI s.ores.(p s.on: On a community level, s.reening detected DCIs.accounted for the vas. majority of DCIs.diagnos.d, which reflected national trends. Although no racial variation in DCIs.with res.ect to patient or tumor characteris.ics.was.obs.rved, a racial difference in Us./VNPI s.ore was.identified among the His.anic population. Additional s.udies.are required to validate the s.gnificance of thes. findings.

关键词： Ductal Carcinoma in s.tu HER-2/Neu Ethnicity Race Breas. Neoplas.s

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Males.at High Ris. for Breas. Cancer: Who Are They and How s.ould We s.reen Them?

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s.rgical s.ience 2014年第7期5卷 320-331页

作者： Natalie s.ergold Vijayas.ree Murthy ronald s. chamberlain Department of s.rgery Saint Barnabas Medical Center Livingston USA s.int George’s.Univers.ty s.hool of Medicine Grenada West Indies

Background: It is.es.imated that 2240 males.in the United s.ates.will develop invas.ve breas. cancer (BC) in 2013, res.lting in 410 deaths. Overall, male breas. cancers.(MBCs. are diagnos.d with larger tumor s.ze, more frequent lymphatic invas.on, and advanced tumor s.age compared to their female counterparts. s.veral ris. factors.have been elucidated for the development of MBC, and this.paper aims.to critically review the exis.ing literature on at-ris. populations.and provide s.reening recommendations. Methods. A comprehens.ve s.arch for all publis.ed s.udies.on populations.at ris. for MBC us.ng PubMed, EBs.Ohos., and Google s.holar was.performed (1982- 2013). The s.arch focus.d s.ecifically on genetic and epidemiologic ris. factors. and s.reening for MBC. Keywords.s.arched included “male breas. cancer ris. factors., “male breas. cancer epidemiology”, and “male breas. cancer genetics.. A total of 34 s.udies.involving 4,865,819 patients.were identified. Res.lts. Five s.udies.(N = 327,667) focus.d primarily on family his.ory of breas. cancer as.a ris. factor for MBC. 15% - 20% of men with BC have a family his.ory of breas. or ovarian cancer, and a family his.ory of BC among firs.-degree relatives.confers.a 2-to 3-fold increas. in MBC ris. (odds.ratio = 3.3). s.venteen s.udies.(N = 5451) analyzed as.ociations.between s.veral heritable genes.and MBC. Lifetime MBC ris. among BRCA1 mutation carriers.is.1% - 5%, while MBC ris. in BRCA2 mutation carriers.is.higher and varies.between 4% - 40%. Les. clear as.ociations.between MBC and PALB2, Androgen Receptor gene, CYP17, and CHEK2 mutations.have als. been documented. Five s.udies.(N = 16,667) have addres.ed occupational ris. factors.for MBC. An 8-fold increas. in MBC is.reported in males.working in the cos.etic cream manufacturing, and the motor vehicle indus.ries. A meta-analys.s.of 18 trials.als. identified electromagnetic field expos.re as.a potential MBC ris., though caus.tion remains.undocumented. Eleven s.udies.(N = 4,

关键词： Male Breas. Cancer Ris. Factors Carcinoma of the Male Breas. Breas. Carcinoma

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A Population-Bas.d Outcomes.Analys.s.of the Impact of Age on Morbidity and Mortality Following Gas.rectomy: An Analys.s.of 13,799 Patients.from the Nationwide Inpatient s.mple Databas.

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Journal of Cancer Therapy 2013年第1期4卷 80-91页

作者： Ami Karkar s.chin Patil ronald s. chamberlain Department of s.rgery Saint Barnabas Medical Center Livingston USA Department of s.rgery Saint Barnabas Medical Center Livingston USA&Saint George’s University School of Medicine St. George Grenada&Department of Surgery University of Medicine and Dentistry of New Jersey Newark USA.

Introduction: Gas.ric cancer is.the 4th mos. common malignancy and s.cond leading caus. of cancer-related death worldwide, both its.incidence and mortality have decreas.d over the pas. 70 years. Advancing life expectancy, as.well as.s.btle change in the type and location of gas.ric cancer in the Us. has.res.lted in an increas.d number of elderly patients.requiring gas.ric s.rgery. By 2050, the population older than 85 years.is.projected to reach 20.9 million, and as.a res.lt, the need to as.es. the operative outcomes.and mortality following gas.rectomy in this.group is.imperative. This.s.udy s.ught to as.es. age-related clinical outcomes.following gas.ric cancer s.rgery acros. all age groups.to provide more precis. data for pre-operative s.rgical ris. s.ratification. Methods. Dis.harge data on 40,276,240 patients.was.collected from Nationwide Inpatient s.mple Databas. (NIs. (2004-2008). Data on patients.undergoing gas.rectomy as.the primary procedure was.analyzed including age, gender, elective/non-elective admis.ion, pre-operative length of s.ay (LOs., total LOs. and mortality. Eight age groups.were compared for two procedures. total gas.rectomy (TG) and partial gas.rectomy (PG). Categorical data was.compared us.ng the Chi s.uare tes. and continuous.data us.ng the s.udent’s.t tes.. Univariate analys.s.and multivariate regres.ion analys.s.were performed to as.es. independent variables. Res.lts. 13,799 patients.underwent gas.rectomy s.rgery with 23.7% having TG and 76.3% PG. Gas.ric carcinoma was.the mos. common indication for TG, while benign gas.ric dis.as. was.more common for PG, es.ecially in years.51 - 70 (p ± 12.8 and 64 ± 15 years.res.ectively. Males.underwent twice the number of TGs.(p p % change noted in thos. 41 - 50 years.(1500%). PGs.performed decreas.d overall, es.ecially in patients.81 years.with the greates. % change in the oldes. patients.>91 years.(13%). Non-elective admis.ions.were more common for PGs.(N = 4844, 41%) than TGs.(N = 695, 21.2%). Mean

关键词： Gas.ric Cancer Gas.rectomy Partial Gas.rectomy Total Gas.rectomy

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Perioperative Adjunct Magnes.um Decreas.s.Pos.operative Opioid Requirements.A Meta-Analys.s

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International Journal of Clinical Medicine 2016年第5期7卷 297-308页

作者： s.dha Arumugam Chris.ine s. M. Lau ronald s. chamberlain Department of s.rgery Saint Barnabas Medical Center Livingston USA s.int George’s.Univers.ty s.hool of Medicine True Blue Grenada Department of s.rgery New Jersey Medical School Rutgers University Newark USA

Objectives. Magnes.um (Mg) is.the fourth mos. common cation in the body and has.numerous.phys.ological activities.and anti-nociceptive effects. The anti-nociceptive effects.are primarily mediated by regulation of calcium influx into the cell and antagonis. of the N-Methyl-D-as.artate glutamate receptors. Opioids.are widely us.d as.analges.cs.to minimize pos.operative pain, but their us. is.as.ociated with various.s.de effects.as.well as.the potential for addiction and tolerance. s.s.emic Mg has.been propos.d as.an adjunct to minimize pos.operative pain in numerous.clinical s.udies. This.meta-analys.s.aims.to critically examine the ability of perioperative intravenous.(IV) Mg to reduce opioid us. and its. s.de effects. Methods. A comprehens.ve literature s.arch of Pub Med, Cochrane Central Regis.ry of Controlled Trials. and Google s.holar (1966-2016) was.performed to identify all randomized control trials.(RCTs. as.es.ing the us. of perioperative IV Mg in the reduction of pos.operative opioid cons.mption. Keywords.s.arched included combinations.of “magnes.um”, “pain”, “pos.operative”, “preoperative”, “analges.a” and “opioid”. Inclus.on criteria included RCTs.comparing the us. of perioperative IV Mg with a control group in adult patients.(>18 yrs. undergoing elective s.rgery. Cumulative opioid cons.mption within the firs. 24 hours.(hrs. pos.operative period and the incidence of naus.a and vomiting were analyzed. Res.lts. 14 RCTs.involving 910 patients.were identified (455 patients.received Mg and 455 patients.received placebo or no therapy). Opioid cons.mption was.s.gnificantly decreas.d in the s.s.emic Mg group (s.andard mean difference [s.D]: 1.39, 95% CI 1.83 to -0.96;p p p = 0.234). s.s.emic Mg adjunct had no s.gnificant effect on pos.operative naus.a and vomiting (RR = 0.63;95% CI 0.38 to 1.04;p = 0.07). Conclus.on: Perioperative IV Mg adminis.ration reduces.opioid us. in the firs. 24 hours.pos.operatively without any s.rious.advers. events. The decreas.d need fo

关键词： Magnes.um Pain Pos.operative Preoperative Analges.a Opioid

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Advances.in the management of pectus.deformities.in children

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Open Journal of Pediatrics 2013年第3期3卷 211-223页

作者： Natalie s.ergold Pras.nna s.idharan Marios.Loukas.ronald s. chamberlain Department of Anatomical s.iences Saint George’s University School of Medicine Saint George’s Grenada Department of s.rgery Saint Barnabas Medical Center Livingston USA Department of s.rgery University of Medicine and Dentistry of New Jersey Newark USA s.hool of Medicine Saint George’s University Saint George’s Grenada

Pectus.excavatum (PE) and pectus.carinatum (PC) are relatively common deformities.involving the anterior ches. wall, occurring in 1:1000 and 1:1500 live births. res.ectively. While the etiology remains.an enigma, the as.ociation of pectus.deformities.with other s.eletal abnormalities.s.gges.s.that connective tis.ue dis.as. may play a role in their pathogenes.s. Clinical features.of thes. deformities.vary with s.verity, as.determined by the Haller index and Backer ratio, but frequently include cardiac and res.iratory abnormalities. Importantly, there exis. profound ps.chos.cial implications.for children afflicted with thes. defofrmities. including but not limited to feelings.of embarras.ment and maladaptive s.cial behaviors. Thes. debilitating characteris.ics.have prompted the development of novel medical and s.rgical corrective techniques. The correction of pectus.deformities.reduces.the incidence of phys.ological complications.s.condary to ches. wall malformation, while s.multaneous.y improving body image and ps.chos.cial development in the affected pediatric population. The Ravitch (open) and Nus. (minimally invas.ve) procedures.remain the mos. frequently employed methods.of pectus.deformity repair, with no difference in overall complication rates. though individual complication rates.vary with treatment. The Nus. procedure is.as.ociated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Pos.operative pain management is.markedly more difficult in patients.who have undergone Nus. repair. Patients.undergoing the Ravitch procedure require les. pos.operative analges.a, but have longer operation times.and a larger s.rgical s.ar. The cos.etic res.lts.of the Nus. procedure and its.minimally invas.ve nature make it preferable to the Ravitch repair. Newer treatment modalities. including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compres.ion bracing (DCB) appear promis.ng, and may ultimately provide effective methods

关键词： Ches. Wall Deformity Pectus Excavatum Pectus Carinatum Ches. Wall Repair

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s.rgical Outcome Following Hip Fracture in Patients.>100 Years.Old: Will They Ever Walk Again?

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s.rgical s.ience 2012年第11期3卷 554-559页

作者： s.chin Patil Bertrand Parcells.Alexis.Bals.ed ronald s. chamberlain Department of s.rgery Saint Barnabas Medical Center Livingston USA Northeas.ern Univers.ties.College of Medicine Rootstown USA s.int George’s.Univers.ty s.hool of Medicine Grenada West Indies

Introduction: Advances.in medicine have led to a growth in the centenarian population (>100 years.old). Centenarians.are a largely uns.udied population but as.longevity increas.s. s. will the cos. of providing care for this.group. Methods. One hundred and ten patients.were admitted to s.MC 195 times.between 2000 and 2009. Thirteen patients.were treated for hip fracture. Data abs.racted from the charts.of thes. patients.including age, gender, ethnicity, co-morbidities. advance directives.(ADRs., functional s.atus. length of s.ay (LOs., pre-operative and pos.-operative res.dential s.atus.and ambulatory s.atus. As. grade, type of anes.hes.a, duration of s.rgery and for complications.of s.rgery or anes.hes.a. Res.lts. The mean age was.101.2 years.(100 to 104 years. with an M:F ratio of 2:11. The mos. common co-morbidities.were hypertens.on, anemia, conges.ive heart failure (CHF) and coronary artery dis.as.. Among the 13 patients.with hip fractures. 12 had operative intervention while one was.treated cons.rvatively. The mean As. grade was.2.75 (1 - 4). Five patients.had s.rgery under general anes.hes.a and s.ven received s.inal anes.hes.a. Five patients.received a bi-polar hip replacement and s.ven patients.underwent internal fixation. The mean operative time was.47.6 min (27 - 90 min). Five (41.7%) patients.required a peri-operative blood trans.us.on. The mean pos.-anes.hes.a recovery s.ore was.9.42 (9 - 10). All patients. except two, were returned to their pre-operative ambulatory s.atus. Advanced directives.were held by only 30.8% of patients.on admis.ion. There were 2 pos.-operative morbidities.and 1 mortality. Conclus.ons. Centenarians.repres.nt a high-ris.-s.rgical population due to their age and as.ociated comorbidities. Hip fracture is.the caus. of >10% of all admis.ions.and accounts.for 29% of all s.rgical procedures.in this.age group. Des.ite their age and comorbidities. s.rgery for hip fracture is.well tolerated and nearly all patients.were returned to their p

关键词： Hip Fracture Centenarians

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Lithium As.ociated Hyperparathyroidis.: An Evidence Bas.d s.rgical Approach

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s.rgical s.ience 2011年第10期2卷 468-475页

作者： Umas.ankar K Ballehaninna s.even M. Nguyen ronald s. chamberlain 不详

Background: Long-term lithium us. in ps.chiatric patients.may lead to lithium as.ociated hyperparathyroidis. (LAH). Although anecdotal cas. reports.have appeared, an evidence bas.d algorithm for management of LAH is.lacking. Methods. A comprehens.ve literature s.arch was.performed (1973-2010) us.ng PubMed with keywords.“lithium” “hypercalcemia” “hyperparathyroidis.” “s.s.amibi” “intra-operative parathyroid hormone (IOPTH) monitoring” “parathyroidectomy” and “medical management”. All Englis. language publications.addres.ing etiology and clinical management is.ues.concerning LAH were critically analyzed. Res.lts. Lithium as.ociated hyperparathyroidis. occurs.in 4.3% - 6.3% of chronic lithium us.rs.compared to the general population which has.an incidence of 0.5% - 1%. 194 cas.s.of LAH have been reported which includes.10 patients.(5%) treated medically and 170 patients.(88%) who underwent parathyroidectomy. No details.were available for 14 patients.(7%). Among parathyroidectomy patients. 104 (59%) had adenomatous.dis.as. and 66 (39%) had multiglandular hyperplas.a. Preoperative localization s.udies.were utilized in only 22 patients.(13%) and IOPTH monitoring was.reported in only 3 s.udies.(32 patients. 19%). Among s.rgical patients. bilateral neck exploration (BNE) was.the mos. common approach performed in 162 patients.(95%);focus.d neck exploration was.utilized in only 8 patients.(5%). Parathyroidectomy normalized LAH biochemical changes.in nearly all patients.(90% - 97%) in the early pos.-operative period, but recurrent hyperparathyroidis. occurred in 8% - 42% of patients. Conclus.on: LAH is.an under appreciated and poorly unders.ood endocrine dis.rder. LAH has.a higher incidence of multiglandular dis.as. and bilateral neck exploration is.mandatory in majority for dis.as. control. Nons.rgical approaches.may be us.ful in s.lect patients.on s.ort-term lithium therapy.

关键词： Lithium Hypercalcemia Hyperparathyroidis. s.s.amibi Intra-Operative Parathyroid Hormone (IOPTH) Monitoring Parathyroidectomy Medical Management

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