in a couple case series looking retrospectively uh at patients who had catheters removed, anywhere from 5 to 15% of patients are going to require some sort of. Additional intervention to remove the catheter.
And the authors brought up that this could potentially be a type 2 error where there was actually a difference between the two groups and the sample size was just a little bit too small to detect that.
quoteThis paper is about patients who have tracheomalacia and specifically it's called Posterior tracheopexy for severe tracheomalacia.↗
▶Ep 1 · 0:24
quoteThe first author is Hester Sche and the last author is Russell Jennings.↗
▶Ep 1 · 0:28
clinicalThe paper examined 98 patients who had severe tracheomalacia with posterior membranous intrusion↗
▶Ep 1 · 0:35
clinicalAll patients underwent bronchoscopy showing the trachea tended to collapse inward from the posterior aspect↗
▶Ep 1 · 0:44
clinicalAnterior compression is from the aortic arch, while posterior compression is from collapse↗
▶Ep 1 · 0:54
clinicalPosterior tracheopexy uses pledgeted sutures to sew the posterior wall of the trachea to the anterior longitudinal ligament of the spine↗
▶Ep 1 · 1:05
epidemiological88% of the 98 patients had esophageal atresia with or without TEF↗
▶Ep 1 · 1:05
clinicalPatients were followed anywhere from 1 week to 36 months↗
▶Ep 1 · 1:15
clinicalClinical symptoms improved across the board, including cough, barking cough, noisy breathing, and infections↗
▶Ep 1 · 1:25
clinicalPatients improved on bronchoscopic evaluation↗
▶Ep 1 · 1:30
clinicalExercise tolerance did not improve statistically but showed a trend towards improvement↗
▶Ep 1 · 1:35
opinionTracheomalacia is not one homogeneous disease↗
▶Ep 1 · 1:35
quoteI think the important thing this paper showed us was that tracheomalacia isn't just one homogeneous disease.↗
▶Ep 1 · 1:41
opinionSystematic bronchoscopic evaluation is important for tracheomalacia↗
▶Ep 1 · 1:45
clinicalSome patients benefit from posterior tracheopexy, some from aortopexy or anterior approach, and some need both↗
▶Ep 1 · 1:54
clinicalApproximately 20% of patients in the study required both posterior tracheopexy and aortopexy↗
Posterior Tracheopexy For Severe Tracheomalacia
▶Ep 2 · 0:16
quoteThis paper is about patients who have tracheomalacia and specifically it's called Posterior tracheopexy for severe tracheomalacia.↗
▶Ep 2 · 0:28
clinicalThe paper studied 98 patients who had severe tracheomalacia with posterior membranous intrusion↗
▶Ep 2 · 0:35
clinicalAll patients received bronchoscopy showing the trachea tended to collapse inward from the posterior aspect↗
▶Ep 2 · 0:44
clinicalAnterior compression is from the aortic arch, while posterior compression is from collapse↗
▶Ep 2 · 0:54
clinicalPosterior tracheopexy involves taking pledgeted sutures and sewing the posterior wall of the trachea to the anterior longitudinal ligament of the spine↗
▶Ep 2 · 1:05
epidemiological88% of the 98 patients had esophageal atresia with or without TEF↗
▶Ep 2 · 1:05
clinicalPatients were followed anywhere from 1 week to 36 months↗
▶Ep 2 · 1:15
clinicalClinical symptoms including cough, barking cough, noisy breathing, and infections improved across the board↗
▶Ep 2 · 1:25
clinicalPatients improved on bronchoscopic evaluation↗
▶Ep 2 · 1:30
clinicalExercise tolerance did not improve statistically but showed a trend towards improvement↗
▶Ep 2 · 1:35
quoteI think the important thing this paper showed us was that tracheomalacia isn't just one homogeneous disease.↗
▶Ep 2 · 1:35
clinicalTracheomalacia is not one homogeneous disease↗
▶Ep 2 · 1:45
clinicalSome patients benefit from posterior tracheopexy, some from aortopexy or anterior approach, and some need both↗
▶Ep 2 · 1:54
clinicalAlmost 20% of patients in the study required both posterior and anterior procedures↗
Esophagogastric Dissociation for GERD in Severe Neurodisability
▶Ep 3 · 0:48
clinicalThe study included patients with severe GERD who were neurologically disabled, with half undergoing esophagogastric dissociation and half undergoing laparoscopic Nissen↗
▶Ep 3 · 1:01
clinicalPrimary outcome was operative failure, defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery↗
▶Ep 3 · 1:01
quotePrimary outcome was operative failure, which they defined as either recurrence of their preoperative reflux symptoms or a requirement of an additional uh anti-reflux surgery.↗
▶Ep 3 · 1:13
clinicalThere was a 21% failure rate in the Nissen group↗
▶Ep 3 · 1:13
quoteSo that was found to be, there was a 4% failure rate in the esophagogastric dissociation group, there was a 21% failure rate in the Nissen group.↗
▶Ep 3 · 1:13
clinicalThere was a 4% failure rate in the esophagogastric dissociation group↗
▶Ep 3 · 1:21
clinicalThe difference in failure rates between esophagogastric dissociation and Nissen was not statistically significant↗
▶Ep 3 · 1:21
quoteHowever, that wasn't statistically significant.↗
▶Ep 3 · 1:29
clinical17% of patients in the esophagogastric dissociation group continued to require anti-reflux medications after surgery↗
▶Ep 3 · 1:29
clinical54% of patients in the Nissen group continued to require anti-reflux medications after surgery↗
▶Ep 3 · 1:29
clinicalThe difference in continued medication requirement between groups was statistically significant↗
▶Ep 3 · 1:39
clinicalCaregiver-evaluated quality of life and symptom scores were the same between the two groups with no statistically significant difference↗
▶Ep 3 · 2:03
opinionThe lack of statistical significance in failure rates could potentially be a type 2 error where there was actually a difference but the sample size was too small to detect it↗
▶Ep 3 · 2:24
clinicalEsophagogastric dissociation is a much bigger surgery than Nissen fundoplication↗
▶Ep 3 · 2:26
clinicalThe study looked at perioperative factors including time in the OR, length of hospital stay, need for ICU stay, and time to full feeds, with statistically significant differences following expected trends↗
▶Ep 3 · 2:39
clinicalThe study did not report on long-term requirement for additional surgeries other than anti-reflux operations↗
clinicalKarydakis flap superior to excision only and comparable to modified Limberg flap for pilonidal disease↗
Esophagogastric Dissociation for GERD in Severe Neurodisability
▶Ep 23 · 0:48
clinicalThe study compared patients with severe GERD who were neurologically disabled, half undergoing esophagogastric dissociation and half undergoing laparoscopic Nissen↗
▶Ep 23 · 1:01
clinicalPrimary outcome was operative failure, defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery↗
▶Ep 23 · 1:01
quotePrimary outcome was operative failure, which they defined as either recurrence of their preoperative reflux symptoms or a requirement of an additional uh anti-reflux surgery.↗
▶Ep 23 · 1:13
quoteSo that was found to be, there was a 4% failure rate in the esophagogastric dissociation group, there was a 21% failure rate in the Nissen group. However, that wasn't statistically significant.↗
▶Ep 23 · 1:13
clinicalThere was a 4% failure rate in the esophagogastric dissociation group↗
▶Ep 23 · 1:13
clinicalThere was a 21% failure rate in the Nissen group↗
▶Ep 23 · 1:21
clinicalThe difference in failure rates between esophagogastric dissociation and Nissen was not statistically significant↗
▶Ep 23 · 1:29
clinicalThe difference in continued medication requirement between groups was statistically significant↗
▶Ep 23 · 1:29
clinical17% of patients in the esophagogastric dissociation group continued to require anti-reflux medications after surgery↗
▶Ep 23 · 1:29
clinical54% of patients in the Nissen group continued to require anti-reflux medications after surgery↗
▶Ep 23 · 1:39
clinicalCaregiver-evaluated quality of life and symptom scores were the same between the two groups with no statistically significant difference↗
▶Ep 23 · 2:03
opinionThe lack of statistical significance in failure rates could potentially be a type 2 error where there was actually a difference but the sample size was too small to detect it↗
▶Ep 23 · 2:03
quoteAnd the authors brought up that this could potentially be a type 2 error where there was actually a difference between the two groups and the sample size was just a little bit too small to detect that.↗
▶Ep 23 · 2:24
clinicalEsophagogastric dissociation is a much bigger surgery than Nissen fundoplication↗
▶Ep 23 · 2:26
clinicalThe study examined perioperative factors including time in the OR, length of hospital stay, need for ICU stay, and time to full feeds, with statistically significant differences following expected trends↗
▶Ep 23 · 2:39
clinicalThe study did not report on leaks, strictures, or long-term requirement for additional surgeries other than anti-reflux operations↗
Management of Retained Central Venous Catheters
▶Ep 25 · 0:32
quotein a couple case series looking retrospectively uh at patients who had catheters removed, anywhere from 5 to 15% of patients are going to require some sort of. Additional intervention to remove the catheter.↗
▶Ep 25 · 0:32
epidemiological5 to 15% of patients who have catheters removed require some sort of additional intervention to remove the catheter↗
▶Ep 25 · 0:57
epidemiologicalThe actual number of catheters or catheter fragments that get left behind is 0.2 to 2%↗
▶Ep 25 · 0:57
quoteThe actual number of catheters or catheter fragments that get left behind is gonna be from 0.2 to 2%.↗
▶Ep 25 · 1:12
clinicalRisk factors for catheter retention include patients who have chemotherapy infused through their lines↗
▶Ep 25 · 1:12
quotethe risk factors for catheter retention seem to be patients who have chemotherapy infused through their lines, patients who have catheters that are indwelling for longer than about a year and a half.↗
▶Ep 25 · 1:12
clinicalRisk factors for catheter retention include patients who have catheters that are indwelling for longer than about a year and a half↗
▶Ep 25 · 1:25
clinicalThere is an association between polyurethane catheter material and catheter retention when compared with silicone catheters↗
▶Ep 25 · 1:25
quotethere seems to be an association with polyurethane catheter material when compared with silicone catheters.↗
▶Ep 25 · 1:46
opinionThe recommendation would be to go with silastic catheters for long-term chemotherapy cases↗
▶Ep 25 · 2:04
quoteI think you need to look at the risks and benefits of leaving some of the catheter behind versus going after it.↗
▶Ep 25 · 2:10
clinicalSurgical venotomy to retrieve a catheter carries a risk of bleeding↗
▶Ep 25 · 2:16
clinicalEndovascular catheter removal carries a risk of the line completely breaking and embolizing distally↗
▶Ep 25 · 2:16
clinicalEndovascular catheter removal carries a risk of thrombosis occurring during the procedure↗
▶Ep 25 · 2:31
quotewhenever multiple studies which have looked at patients who actually had retained catheter fragments in follow-up periods from months to the order of 5 years, there weren't any complications.↗
▶Ep 25 · 2:31
clinicalMultiple studies of patients with retained catheter fragments in follow-up periods from months to the order of 5 years showed no complications↗
▶Ep 25 · 2:42
clinicalNo infections were associated with retained catheter fragments in follow-up studies↗
▶Ep 25 · 2:42
quoteSo, no thrombosis associated with the line. Fragments and no infections.↗
▶Ep 25 · 2:42
clinicalNo thrombosis was associated with retained catheter fragments in follow-up studies↗
Do we need Bowel Prep
▶Ep 26 · 0:35
quoteMechanical bowel prep alone in adults is doing them no good or probably harming them, and oral antibiotics that aren't absorbed are probably a good idea.↗
▶Ep 26 · 0:35
clinicalAdult prospective randomized trials show mechanical bowel prep alone does no good or probably harms patients↗
▶Ep 26 · 0:41
clinicalOral antibiotics that are not absorbed are probably beneficial in adult colorectal surgery↗
▶Ep 26 · 0:51
clinicalIn one pediatric study, addition of antibiotics to mechanical bowel prep did not make any difference in outcomes↗
▶Ep 26 · 0:51
quoteOne study showed that mechanical bowel prep by itself led to a higher rate of infection and longer hospital stays in kids, and addition of antibiotics didn't make any difference.↗
▶Ep 26 · 0:51
clinicalOne pediatric study showed mechanical bowel prep by itself led to longer hospital stays in children↗
▶Ep 26 · 0:51
clinicalOne pediatric study showed mechanical bowel prep by itself led to higher infection rates in children↗
▶Ep 26 · 1:01
clinicalAnother pediatric study showed mechanical bowel prep with oral antibiotics made no difference compared to no prep↗
▶Ep 26 · 1:07
quoteI think for your patient, it probably makes sense to not do either one.↗
▶Ep 26 · 1:07
opinionFor pediatric colostomy takedown, it is reasonable to omit both mechanical bowel prep and oral antibiotics↗
