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P Stadler - One of the best experts on this subject based on the ideXlab platform.
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diagnostics of non acute vascular Prosthesis Infection using 18f fdg pet ct our experience with 96 prostheses
European Journal of Nuclear Medicine and Molecular Imaging, 2009Co-Authors: Miroslav Spacek, O Belohlavek, J Votrubova, P Sebesta, P StadlerAbstract:Vascular Prosthesis Infection (VPI) is a life-threatening complication that occurs in 0.5–5% of prostheses. Low-grade Infections in non-acute patients are a diagnostic challenge requiring a new method with good diagnostic accuracy. The aim of this work was to define the accuracy of 18F-FDG PET/CT in these settings and to identify essential parameters of the evaluation. PET/CT was performed prospectively in 76 consecutive patients with a total of 96 vascular prosthetic grafts in which Infection was suspected. PET/CT scans were analysed in terms of the presence and intensity of focal and diffuse FDG uptake, the presence of an anastomotic pseudoaneurysm, the presence of an irregular boundary of infiltration, a combination of these, and the uptake ratio between the graft and blood background. The gold standard was based on operative/histopathological finding or a clinical follow up of >6 months. Among the various assessed parameters only focal FDG uptake and an irregular graft boundary were significant predictors of VPI. Focal intense FDG uptake together with an irregular boundary of the lesion on CT scan predicted VPI with 97% probability, while smooth lesion boundaries and no focal FDG uptake predicted a probability of VPI of less than 5%. Even in lesions with nondiagnostic inhomogeneous focal FDG uptake (18/96) an irregular boundary effectively helped in decision-making with a probability of 28% (smooth) or 77% (irregular) for VPI. PET/CT gave reliable results with an accuracy >95% in 75% of prostheses. PET/CT can identify those prostheses (25% of Prosthesis) for which its diagnostic accuracy is diminished to 70–75%. In our series PET/CT was an excellent diagnostic modality for suspected VPI.
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diagnostics of non acute vascular Prosthesis Infection using 18f fdg pet ct our experience with 96 prostheses
European Journal of Nuclear Medicine and Molecular Imaging, 2009Co-Authors: Miroslav Spacek, O Belohlavek, J Votrubova, P Sebesta, P StadlerAbstract:INTRODUCTION Vascular Prosthesis Infection (VPI) is a life-threatening complication that occurs in 0.5-5% of prostheses. Low-grade Infections in non-acute patients are a diagnostic challenge requiring a new method with good diagnostic accuracy. The aim of this work was to define the accuracy of (18)F-FDG PET/CT in these settings and to identify essential parameters of the evaluation. MATERIAL AND METHODS PET/CT was performed prospectively in 76 consecutive patients with a total of 96 vascular prosthetic grafts in which Infection was suspected. PET/CT scans were analysed in terms of the presence and intensity of focal and diffuse FDG uptake, the presence of an anastomotic pseudoaneurysm, the presence of an irregular boundary of infiltration, a combination of these, and the uptake ratio between the graft and blood background. The gold standard was based on operative/histopathological finding or a clinical follow up of >6 months. RESULTS Among the various assessed parameters only focal FDG uptake and an irregular graft boundary were significant predictors of VPI. Focal intense FDG uptake together with an irregular boundary of the lesion on CT scan predicted VPI with 97% probability, while smooth lesion boundaries and no focal FDG uptake predicted a probability of VPI of less than 5%. Even in lesions with nondiagnostic inhomogeneous focal FDG uptake (18/96) an irregular boundary effectively helped in decision-making with a probability of 28% (smooth) or 77% (irregular) for VPI. CONCLUSION PET/CT gave reliable results with an accuracy >95% in 75% of prostheses. PET/CT can identify those prostheses (25% of Prosthesis) for which its diagnostic accuracy is diminished to 70-75%. In our series PET/CT was an excellent diagnostic modality for suspected VPI.
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diagnosis of vascular Prosthesis Infection with fdg pet ct
Journal of Vascular Surgery, 2004Co-Authors: P Stadler, Miroslav Spacek, Otakar Bilohlavek, Pavel MichalekAbstract:Fluorodeoxyglucose positron emission tomography (FDG-PET) is on the verge of becoming an established imaging tool in the fields of clinical oncology, cardiology, and neurology. Because of the high glucose uptake of inflammatory cells, FDG scanning is an appropriate tool for use in tracing suspected inflammation or to evaluate Infection. PET, although highly sensitive, often lacks the ability to define the precise anatomic location of abnormal FDG accumulation. The new PET/computed tomography (CT) technology provides precise registration of metabolic and structural imaging data in a single session. We report positive FDG-PET/CT findings in an infected vascular Prosthesis 6 months after grafting. Our experience and a few available case reports support the hypothesis that FDG-PET/CT may have a promising role in future noninvasive diagnosis of infected vascular grafts.
E Spaziani - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic trans abdominal pre peritoneal tapp surgery for incarcerated inguinal hernia repair
Hernia, 2019Co-Authors: Raffaello Mancini, G Pattaro, E SpazianiAbstract:This series was aimed to analyze feasibility, safety and postoperative quality of life of trans-abdominal pre-peritoneal repair in incarcerated hernia; the rationale was a safe hernia reduction, more accurate abdomen exploration, diagnosis and treatment of contralateral unknown hernia. With a minimum follow-up of 30 months, 20 urgent incarcerated inguinal hernia patients were submitted to TAPP. Signs of strangulation, peritonitis and major comorbidity were exclusion criteria. Feasibility and safety were evaluated by ability to hernia reduction, conversion rate, operative time, perioperative mortality, morbidity, hospital stay, Prosthesis Infection and recurrence. Finally, quality of life was assessed by acute and chronic pain score, recovery of normal activities, return to work and patients’ satisfaction survey. Under vision sac reduction was always achieved, incision of internal ring during the reduction manoeuvre was necessary in 40% of pts, intraoperative complications, conversions or perioperative mortality were not observed. In one case (5%) partial omentectomy was necessary. Contralateral hernia was diagnosed and repaired in 20%. Median operative time was 81.3 min, postoperative minor complications were recorded in 5 patients (25%), median in hospital stay was 2 days. After a median follow-up of 39 months, 1 patient recurred (5%). Acute pain, was scored 3 as median value (range 1–5), only one patient scored 2 as chronic pain during follow-up. Laparoscopic approach for incarcerated inguinal hernia repair is not the standard treatment. In our experience, with the limit of a single-surgeon series, selected patients showed satisfactory results in terms of feasibility, safety, postoperative quality of life and patients’ satisfaction were observed. Few series about this topic were published. More prospective trials are needed.
Miroslav Spacek - One of the best experts on this subject based on the ideXlab platform.
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diagnostics of non acute vascular Prosthesis Infection using 18f fdg pet ct our experience with 96 prostheses
European Journal of Nuclear Medicine and Molecular Imaging, 2009Co-Authors: Miroslav Spacek, O Belohlavek, J Votrubova, P Sebesta, P StadlerAbstract:Vascular Prosthesis Infection (VPI) is a life-threatening complication that occurs in 0.5–5% of prostheses. Low-grade Infections in non-acute patients are a diagnostic challenge requiring a new method with good diagnostic accuracy. The aim of this work was to define the accuracy of 18F-FDG PET/CT in these settings and to identify essential parameters of the evaluation. PET/CT was performed prospectively in 76 consecutive patients with a total of 96 vascular prosthetic grafts in which Infection was suspected. PET/CT scans were analysed in terms of the presence and intensity of focal and diffuse FDG uptake, the presence of an anastomotic pseudoaneurysm, the presence of an irregular boundary of infiltration, a combination of these, and the uptake ratio between the graft and blood background. The gold standard was based on operative/histopathological finding or a clinical follow up of >6 months. Among the various assessed parameters only focal FDG uptake and an irregular graft boundary were significant predictors of VPI. Focal intense FDG uptake together with an irregular boundary of the lesion on CT scan predicted VPI with 97% probability, while smooth lesion boundaries and no focal FDG uptake predicted a probability of VPI of less than 5%. Even in lesions with nondiagnostic inhomogeneous focal FDG uptake (18/96) an irregular boundary effectively helped in decision-making with a probability of 28% (smooth) or 77% (irregular) for VPI. PET/CT gave reliable results with an accuracy >95% in 75% of prostheses. PET/CT can identify those prostheses (25% of Prosthesis) for which its diagnostic accuracy is diminished to 70–75%. In our series PET/CT was an excellent diagnostic modality for suspected VPI.
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diagnostics of non acute vascular Prosthesis Infection using 18f fdg pet ct our experience with 96 prostheses
European Journal of Nuclear Medicine and Molecular Imaging, 2009Co-Authors: Miroslav Spacek, O Belohlavek, J Votrubova, P Sebesta, P StadlerAbstract:INTRODUCTION Vascular Prosthesis Infection (VPI) is a life-threatening complication that occurs in 0.5-5% of prostheses. Low-grade Infections in non-acute patients are a diagnostic challenge requiring a new method with good diagnostic accuracy. The aim of this work was to define the accuracy of (18)F-FDG PET/CT in these settings and to identify essential parameters of the evaluation. MATERIAL AND METHODS PET/CT was performed prospectively in 76 consecutive patients with a total of 96 vascular prosthetic grafts in which Infection was suspected. PET/CT scans were analysed in terms of the presence and intensity of focal and diffuse FDG uptake, the presence of an anastomotic pseudoaneurysm, the presence of an irregular boundary of infiltration, a combination of these, and the uptake ratio between the graft and blood background. The gold standard was based on operative/histopathological finding or a clinical follow up of >6 months. RESULTS Among the various assessed parameters only focal FDG uptake and an irregular graft boundary were significant predictors of VPI. Focal intense FDG uptake together with an irregular boundary of the lesion on CT scan predicted VPI with 97% probability, while smooth lesion boundaries and no focal FDG uptake predicted a probability of VPI of less than 5%. Even in lesions with nondiagnostic inhomogeneous focal FDG uptake (18/96) an irregular boundary effectively helped in decision-making with a probability of 28% (smooth) or 77% (irregular) for VPI. CONCLUSION PET/CT gave reliable results with an accuracy >95% in 75% of prostheses. PET/CT can identify those prostheses (25% of Prosthesis) for which its diagnostic accuracy is diminished to 70-75%. In our series PET/CT was an excellent diagnostic modality for suspected VPI.
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diagnosis of vascular Prosthesis Infection with fdg pet ct
Journal of Vascular Surgery, 2004Co-Authors: P Stadler, Miroslav Spacek, Otakar Bilohlavek, Pavel MichalekAbstract:Fluorodeoxyglucose positron emission tomography (FDG-PET) is on the verge of becoming an established imaging tool in the fields of clinical oncology, cardiology, and neurology. Because of the high glucose uptake of inflammatory cells, FDG scanning is an appropriate tool for use in tracing suspected inflammation or to evaluate Infection. PET, although highly sensitive, often lacks the ability to define the precise anatomic location of abnormal FDG accumulation. The new PET/computed tomography (CT) technology provides precise registration of metabolic and structural imaging data in a single session. We report positive FDG-PET/CT findings in an infected vascular Prosthesis 6 months after grafting. Our experience and a few available case reports support the hypothesis that FDG-PET/CT may have a promising role in future noninvasive diagnosis of infected vascular grafts.
Raffaello Mancini - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic trans abdominal pre peritoneal tapp surgery for incarcerated inguinal hernia repair
Hernia, 2019Co-Authors: Raffaello Mancini, G Pattaro, E SpazianiAbstract:This series was aimed to analyze feasibility, safety and postoperative quality of life of trans-abdominal pre-peritoneal repair in incarcerated hernia; the rationale was a safe hernia reduction, more accurate abdomen exploration, diagnosis and treatment of contralateral unknown hernia. With a minimum follow-up of 30 months, 20 urgent incarcerated inguinal hernia patients were submitted to TAPP. Signs of strangulation, peritonitis and major comorbidity were exclusion criteria. Feasibility and safety were evaluated by ability to hernia reduction, conversion rate, operative time, perioperative mortality, morbidity, hospital stay, Prosthesis Infection and recurrence. Finally, quality of life was assessed by acute and chronic pain score, recovery of normal activities, return to work and patients’ satisfaction survey. Under vision sac reduction was always achieved, incision of internal ring during the reduction manoeuvre was necessary in 40% of pts, intraoperative complications, conversions or perioperative mortality were not observed. In one case (5%) partial omentectomy was necessary. Contralateral hernia was diagnosed and repaired in 20%. Median operative time was 81.3 min, postoperative minor complications were recorded in 5 patients (25%), median in hospital stay was 2 days. After a median follow-up of 39 months, 1 patient recurred (5%). Acute pain, was scored 3 as median value (range 1–5), only one patient scored 2 as chronic pain during follow-up. Laparoscopic approach for incarcerated inguinal hernia repair is not the standard treatment. In our experience, with the limit of a single-surgeon series, selected patients showed satisfactory results in terms of feasibility, safety, postoperative quality of life and patients’ satisfaction were observed. Few series about this topic were published. More prospective trials are needed.
Doron S. Stember - One of the best experts on this subject based on the ideXlab platform.
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diabetes is a risk factor for inflatable penile Prosthesis Infection analysis of a large statewide database
Sexual Medicine, 2019Co-Authors: Michael J. Lipsky, Ifeanyi Onyeji, Ron Golan, Ricardo Munarriz, James A. Kashanian, Doron S. Stember, Peter J. StahlAbstract:Abstract Introduction Although diabetes mellitus (DM) is often discussed as a risk factor for inflatable penile Prosthesis (IPP) Infection, the link between DM diagnosis and IPP Infection remains controversial. High-quality population-based data linking DM to an increased risk of IPP Infection have not been published. Aim To evaluate the association of DM with IPP Infection in a large public New York state database. Methods The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for men who underwent initial IPP insertion from 1995–2014. Diabetic patients were identified using ICD-9-CM codes. Patients presenting for first operation with diagnosis or Current Procedural Terminology codes suggestive of prior IPP surgery were excluded. Chi-squared analyses were performed to compare Infection rates in diabetics and non-diabetics within the pre- and postantibiotic impregnated eras. Multivariate Cox proportional hazards models were constructed to evaluate whether or not DM was independently associated with IPP Infection in the time periods before (1995–2003) and after (2004–2014) the widespread availability of antibiotic impregnated penile prostheses. Main Outcome Measure Time to Prosthesis Infection was measured. Results 14,969 patients underwent initial IPP insertion during the study period. The overall Infection rate was 343/14,969 (2.3%). Infections occurred at a median 3.9 months after implant (interquartile ratio: 1.0–25.0 months). Infectious complications were experienced by 3% (133/4,478) of diabetic patients and 2% (210/10,491) of non-diabetic patients (P Conclusion Our analysis supports the notion that DM is a risk factor for IPP Infection. This has important implications for patient selection and counseling, and raises the question of whether this increased risk can be mitigated by optimization of glycemic control before surgery. Lipsky MJ, Onyeji I, Golan R, et al. Diabetes Is a Risk Factor for Inflatable Penile Prosthesis Infection: Analysis of a Large Statewide Database. Sex Med 2019;7:35–40.
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Diabetes Is a Risk Factor for Inflatable Penile Prosthesis Infection: Analysis of a Large Statewide Database
Elsevier, 2019Co-Authors: Michael J. Lipsky, Ifeanyi Onyeji, Ron Golan, Ricardo Munarriz, James A. Kashanian, Doron S. Stember, Peter J. StahlAbstract:Introduction: Although diabetes mellitus (DM) is often discussed as a risk factor for inflatable penile Prosthesis (IPP) Infection, the link between DM diagnosis and IPP Infection remains controversial. High-quality population-based data linking DM to an increased risk of IPP Infection have not been published. Aim: To evaluate the association of DM with IPP Infection in a large public New York state database. Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for men who underwent initial IPP insertion from 1995–2014. Diabetic patients were identified using ICD-9-CM codes. Patients presenting for first operation with diagnosis or Current Procedural Terminology codes suggestive of prior IPP surgery were excluded. Chi-squared analyses were performed to compare Infection rates in diabetics and non-diabetics within the pre- and postantibiotic impregnated eras. Multivariate Cox proportional hazards models were constructed to evaluate whether or not DM was independently associated with IPP Infection in the time periods before (1995–2003) and after (2004–2014) the widespread availability of antibiotic impregnated penile prostheses. Main Outcome Measure: Time to Prosthesis Infection was measured. Results: 14,969 patients underwent initial IPP insertion during the study period. The overall Infection rate was 343/14,969 (2.3%). Infections occurred at a median 3.9 months after implant (interquartile ratio: 1.0–25.0 months). Infectious complications were experienced by 3% (133/4,478) of diabetic patients and 2% (210/10,491) of non-diabetic patients (P < .001). Diabetes was associated with a significantly increased IPP Infection risk on multivariable analysis controlling for age, race, comorbidities, insurance status, annual surgeon volume, and era of implantation (Hazard Ratio: 1.32, 95% CI: 1.05–1.66, P = .016). Conclusion: Our analysis supports the notion that DM is a risk factor for IPP Infection. This has important implications for patient selection and counseling, and raises the question of whether this increased risk can be mitigated by optimization of glycemic control before surgery.Lipsky MJ, Onyeji I, Golan R, et al. Diabetes Is a Risk Factor for Inflatable Penile Prosthesis Infection: Analysis of a Large Statewide Database. Sex Med 2019;7:35–40. Key Words: Erectile Dysfunction, IPP, Penile Implant, Diabetes, Infectio
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use of a preoperative checklist reduces risk of penile Prosthesis Infection
The Journal of Urology, 2014Co-Authors: Benjamin F Katz, Geoffrey Gaunay, Yagil Barazani, Christian J Nelson, Daniel M Moreira, Caner Z Dinlenc, Harris M Nagler, Doron S. StemberAbstract:Purpose: Infection of a penile Prosthesis is a devastating complication that necessitates the removal of all device components. Many aspects of preoperative and intraoperative Infection prophylaxis practices have been examined but the specific relevant factors remain unknown. We determined whether use of a mandatory checklist of perioperative practices believed to reduce the risk of Prosthesis Infection would impact patient safety.Materials and Methods: We retrospectively reviewed men with erectile dysfunction who underwent penile Prosthesis insertion. Only patients who had not previously undergone penile Prosthesis surgery were included in the study. After an outbreak of Infections, a mandatory checklist comprised of best Infection prophylaxis practices was developed and was required for all subsequent implant surgeries. Patient cohorts were divided into 3 groups of baseline period, outbreak period and intervention period. Statistical analysis was performed using the chi-square test, Fisher's exact test ...
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perioperative prevention of penile Prosthesis Infection practice patterns among surgeons of smsna and issm
The Journal of Sexual Medicine, 2012Co-Authors: Darren J Katz, Doron S. Stember, Christian J Nelson, John P MulhallAbstract:ABSTRACT Introduction Anecdotally, there is great variation in the use of strategies to prevent postoperative penile implant Infection. Aim To evaluate the perioperative practice patterns of surgeons who insert penile prostheses focusing on their respective Infection control routines. Method An anonymous Web-based survey was sent to members of the Sexual Medicine Society of North America (SMSNA) and the International Society of Sexual Medicine (ISSM). Main Outcome Measures Thirty-nine questions were asked pertaining to the strategies used during the pre-, intra-, and postoperative phases of penile implant surgery to prevent Infection. Results One hundred twenty-nine surgeons responded to the survey (SMSNA 84; ISSM 45). Most surgeons considered themselves sexual medicine specialists. More SMSNA respondents had inserted >100 Prosthesis (SMSNA 69%, ISSM 50%). Routine urine culture is not performed by 40% and 50% of SMSNA and ISSM members, respectively. Similar percentages of surgeons from each society request a daily preoperative antimicrobial scrub. About two-thirds of ISSM members use razors for the preoperative shave compared with one-third of SMSNA members. Most ISSM surgeons preferred povidone-iodine for hand and skin preparation while most SMSNA surgeons chose this only for skin preparation. Two-thirds of SMSNA members prepared the skin for at least 10 minutes compared with 34% of ISSM surgeons. There were considerable differences in all aspects of antibiotic usage not only between members of both societies but also among individual members of each society. Most surgeons prefer not to place a drain (SMSNA 70%, ISSM 81%). Discharge timing differs between the two groups. Conclusions There is great variation in perioperative strategies utilized to prevent penile implant Infections including some key differences between surgeons from SMSNA and ISSM. It is unknown if these variations result in changes in the postoperative Infection rate; however, the study data may assist in the formation of practice guidelines and form the basis of future prospective studies. Katz DJ, Stember DS, Nelson CJ, and Mulhall JP. Perioperative prevention of penile Prosthesis Infection: Practice patterns among surgeons of SMSNA and ISSM. J Sex Med 2012;9:1705–1714.
