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Direct cost variance analysis of peroral endoscopic myotomy vs heller myotomy for management of achalasia:A tertiary referral center experience

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World Journal of Gastrointestinal Endoscopy 2023年第10期15卷 593-601页

作者： Syedreza Ali Haider Gregory S Bills C Prakash Gyawali Passisd Laoveeravat Jordan Miller Samir Softic Mihir S Wagh Moamen Gabr Department of Internal Medicine Washington University School of Medicine St.LouisSt.LouisMO 63018United States Department of Digestive Disease and Nutrition University of Kentucky College of MedicineLexingtonKY 40508United States Department of Internal Medicine Washington University School of Medicine St.Louis and Barnes Jewish HospitalSt.LouisMO 63108United States Department of Cardiothoracic Surgery University of Kentucky College of MedicineLexingtonKY 40508United States Department of Pediatrics University of Kentucky College of Medicine and Kentucky Children’s HospitalLexingtonKY 40508United States Interventional Endoscopy Division of GastroenterologyUniversity of Colorado School of MedicineAuroraCO 80045United States Department of Advanced Endoscopy Beth Israel Deaconess Medical CenterBostonMA 02215United States

BACKGROUND Laparoscopic Heller myotomy(LHM)has been the traditional surgical treatment for ***,peroral endoscopic myotomy(POEM)has demonstrated similar clinical outcomes with shorter procedure *** comparing the direct cost-effectiveness of POEM vs LHM are *** To compare costs of POEM vs *** Haider SA et *** costs:POEM vs Heller myotomy WJGE https://*** 594 October 16,2023 Volume 15 Issue 10 This retrospective chart review aimed to compare the outcomes and cost of clinical care between patients who underwent POEM and LHM procedures for *** study was conducted at a tertiary academic center from January 2019 to December *** outcomes,including post-operative Eckardt scores and adverse events,were assessed and compared between the two *** cost variance analysis was utilized to evaluate the cost of clinical care incurred by patients undergoing POEM in the year preceding the procedure,during the index admission,and one year post-procedure,in comparison to patients undergoing *** Of 30 patients were included(15 POEM and 15 LHM)in the *** in the POEM group had a mean Eckardt score of 0.5±0.5 post-procedure,which was no different from patients in the LHM group(0.7±0.6,P=0.17)indicating comparative ***,the total costs of the admission for the procedure in the LHM group were on average$1827 more expensive than in the POEM group(P<0.01).Total healthcare costs one year prior to index procedure were$7777 higher in the LHM group,but not statistically different(P=0.34).The patients in the LHM group one year after the index procedure had accrued$19730.24 larger total cost,although this was not statistically different from POEM group(P=0.68).CONCLUSION Despite similar clinical outcomes,the cost of the index procedure admission for POEM was significantly lower than for *** difference was primarily related to shorter time increments utilized in the operating roo

关键词： Peroral endoscopic myotomy Cost analysis Laparoscopic Heller myotomy Achalasia

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肛周鲍温病患者的预后、患其他恶性疾病的风险和正规映像检查的必要性

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世界核心医学期刊文摘（胃肠病学分册） 2005年第3期1卷 21-21页

作者： Margenthaler J.A. Dietz D.W. Mutch M.G. J.W. Fleshman 陈云茹 Department of Surgery Barnes Jewish Hospital Campus Box 8109 660 S. Euclid Street St. Louis MO 63110 United States Dr.

PURPOSE: Local excision is standard treatment for Bowen’s disease, but controversy exists over the incidence of synchronous and metachronous cancers as well as the role of a preexcision mapping procedure. METHODS: The medical records of 25 patients treated for perianal Bowen’s disease between 1978 and 2001 were retrospectively reviewed. RESULTS: There were 11 men and 14 women with a mean age at diagnosis of 47.9 ±14.9 years. The majority of patients (72 percent) had symptom driven biopsies. Presentation included pruritus (56 percent), mass (28 percent), bleeding (24 percent), and anal pain (4 percent). The average duration of symptoms before diagnosis was 1.3 ±0.5 years. Two patients had microscopic disease discovered incidentally after hemorrhoidectomy and underwent no further treatment. Twenty three patients underwent wide local excision, of which 19 (83 percent) had a formal mapping procedure. On final pathology, 23 patients (92 percent) had clear margins. There were three recurrences (mean time to recur 2.0 ±1.0 years), including the two patients who had positive margins after wide excision (1 after mapping) and one patient who had clear margins after mapping. Five patients (20 percent) had other carcinomas (1 sigmoid, 4 vulvar). At follow up, 24 patients were alive with no evidence of Bowen’s disease and 1 patient was dead secondary to sigmoid cancer with no evidence of Bowen’s disease. CONCLUSIONS: Wide excision of perianal Bowen’s disease results in excellent local control, although this is highly dependent on clear pathologic margins. A formal mapping procedure does not preclude recurrence. Initial screening and follow up regimens are not uniform because of the wide range of treatment options available.

关键词：鲍温病肛周肛门痛痔切除术局部切除术切缘阳性广泛切除术早期筛查复发时间异时发生

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人乳头瘤病毒分型与吸烟是早期宫颈癌患者存活期的预测因子

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世界核心医学期刊文摘（妇产科学分册） 2005年第10期1卷 44-44页

作者： Wright J.D Gerhard D.S 侯巍 Division of Gynecologic Oncology Department of Obstetrics and Gynecology Washington University School of Medicine 4911 Barnes Hospital Plaza St. Louis MO 63110 United States

Objective. Molecular and environmental co- factors are known risk factors for cervical cancer. The aim of this study was to define the prognostic significance of HPV 18 and its phylogenetically related viruses and smoking on survival in patients with early stage cervical cancer. Methods. HPV typing was performed on stage IB- IIB cervical tumors. Subjects positive for HPV 18 or 45 were compared to the remainder of the cohort and to women with tumors containing HPV 16, 31, or 52. Tobacco use was ascertained by patient questionnaire. Results. Tumors of 255 women were evaluated. The presence of HPV 18 or 45 was associated with decreased survival. In a multivariable Cox proportional hazards analysis comparing patients with HPV 18 or 45 containing tumors to the rest of the cohort, the hazard ratio for death from cervical cancer was 2.08 (95% CI, 1.07- 4.04). The hazard ratio for death from cervical cancer was 2.41 (95% CI, 1.17- 4.96) when the HPV 18 and 45 group was compared to women with HPV 16 or its related viruses, 31 and 52. Smoking was associated with a decreased survival for women with HPV 18 or 45, even after adjusting for other known prognostic factors (P = 0.031). Conclusions. In addition to pathologic indicators, molecular and environmental co- factors are important determinates of outcome in early stage cervical cancer. The presence of HPV 18 or 45 is associated with a decreased survival. The adverse effect of HPV 18 and 45 on survival is compounded by tobacco use.

关键词：早期宫颈癌人乳头瘤病毒存活期预测意义模型分析环境因素

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未明确诊断意义的非典型鳞状细胞在未婚与已婚女性中的研究

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世界核心医学期刊文摘（妇产科学分册） 2005年第8期1卷 16-16页

作者： Wright J.D. Pinto A.B. Powell M.A. 李跃萍 Dr.Division of Gynecologic Oncology Department of Obstetrics Washington Univ. School of Medicine 4911 Barnes Hospital Plaza St. Louis MO 63110 United States

OBJECTIVE: To estimate the outcome of adolescents with atypical squamous cells of undetermined significance (ASC-US) on cytology. METHODS: A review of ASC-US cytology in girls and women aged 10-19 years between 1995 and 1999 was performed. The cytologic and histologic follow-up of each patient was evaluated. The outcome was recorded as the most significant (highest grade) subsequent cervical smear or biopsy. RESULTS: Overall, 535 of 7,897 (6.8%) cervical cytologic specimens were reported as ASC-US. The study group consisted of 398 patients for whom pathologic follow-up was available. The mean duration of follow-up was 19 months. Follow-up consisted of repeat cytology in 251 (63%) patients and colposcopy with cervical biopsies and/or endocervical curettage in 147 (37%) of the adolescents. Two hundred fifty-three (64%) adolescents had no pathologic abnormalities on follow-up. Persistent ASC-US was identified in 65 (16%), low-grade squamous intraepithelial lesions/cervical intraepithelial neoplasia (CIN) 1 was found in 44 (11%) and high-grade squamous intraepithelial lesions/CIN 2 or 3 occurred in 36 (9%) of the adolescents. No cases of invasive carcinoma were found. CONCLUSIONS: Among adolescents with ASC-US, the rate of squamous intraepithelial lesions/CIN is similar to that of admits. Although the optimal management of ASC-US in adolescents is unknown, these patients warrant close follow-up.

关键词：非典型鳞状细胞已婚女性宫颈活检宫颈涂片宫颈内膜阴道镜瘤样病变随访过程浸润癌青春期女性

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眶底骨折的碎骨引起眼内异物

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世界核心医学期刊文摘（眼科学分册） 2005年第8期1卷 30-30页

作者： Garg S.J. Benson W. Fineman M. Bilyk J.R. 刘玮 barnes Retina Institute Dept. of Ophthalmol. and Vis. Sci. Washington University 660 South Euclid Avenue St. Louis MO 63144 United States Dr.

PURPOSE: To describe the ophthalmoscopic and radiologic findings of a patient who sustained blunt orbital trauma. A piece of bone from the fractured orbital wall caused an intraocular foreign body. DESIGN: Case report. METHODS: An 18-yea r-old man underwent full ophthalmoscopic examination 1 week after sustaining bl unt ocular trauma to the right eye while playing basketball. B-scan ultrasonogr aphy and computed tomography of the orbits were also performed. RESULTS: Visual acuity, intraocular pressure, and anterior segment examination were normal. Fund uscopic examination revealed a fragment of bone that had penetrated the sclera, choroid, and retina. A hole in the sclera was visible. No treatment was performe d. Three months later, the patient had no ocular complaints or complications as a result of this injury. CONCLUSION: Bone from a patient’s orbit may cause an i ntraocular foreign body that may be followed conservatively in certain circumsta nces.

关键词：眼内异物眶底碎骨眼外伤检眼镜检查眶壁眼前节放射检查保守性眼部症状

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胰腺微创手术迈阿密国际循证指南(2020)

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肝胆外科杂志 2020年第6期28卷 478-480页

作者： Asbun HJ 崔笑(译) 耿小平(审校) Division of Hepatobiliary and Pancreas Surgery Miami Cancer Institute Miami FL. Department of Surgery University Hospital Southampton NHS Foundation Trust Southampton UK. Department of Surgery Amsterdam UMC University of Amsterdam Amsterdam the Netherlands. Department of Surgery San Raffaele Hospital Milan Italy. Division of Hepatopancreatobiliary and Endocrine Surgery Virginia Mason Medical Center Seattle VA. Department of Surgery Memorial Sloan Kettering Cancer Center New York City NY. Division of Pancreatic Surgery University Hospital of Verona Verona Italy. Department of Surgery and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden. Division of General and Transplant Surgery University of Pisa Pisa Italy. Department of General and Gastrointestinal Surgery Beth Israel Deaconess Medical Center Boston MA. Department of Surgery Division of Surgical Oncology University of Colorado Denver CO. Department of Abdominal Surgery AC Camargo Cancer Center São Paulo Brazil. Department of Surgery St. Elizabeth's Medical Center Boston MA. Wessex Institute University of Southampton UK. General Surgery and Liver Transplant Unit Department of General Surgery Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy. Department of Surgery Medical School University of Cyprus Cyprus. Department of Surgery Beaujon Hospital Paris France. Department of Surgery University of Oklahoma Oklahoma City OK. The Intervention Centre and Department of HPB Surgery Oslo University Hospital and Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway. Division of Minimally Invasive General Surgery & Robotic Surgery University of Illinois Chicago IL. Department of Surgery Seoul National University Hospital Seoul South Korea. Department of Surgery Portland Providence Medical Center Portland OR. Department of Surgery University of Texas Southwestern Medical Center Dallas TX. Department of Surgery Nor

国际微创胰腺外科研究组(I-MIPS)基于2019年迈阿密国际微创胰腺手术会议专家共识及既往研究的基础上制定了微创胰腺手术国际性循证指南,对微创胰腺手术规范、技术、开展条件和手术效果等6大议题26个临床热点问题进行了系统评价。对有明... 详细信息

国际微创胰腺外科研究组(I-MIPS)基于2019年迈阿密国际微创胰腺手术会议专家共识及既往研究的基础上制定了微创胰腺手术国际性循证指南,对微创胰腺手术规范、技术、开展条件和手术效果等6大议题26个临床热点问题进行了系统评价。对有明确推荐意见的热点问题予以摘译如下:问题1不考虑适应症,在条件合适时|微创远端胰腺切除术相对开放手术应当优先使用吗?

关键词：胰腺手术循证指南胰腺外科推荐意见开放手术优先使用专家共识迈阿密

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