The Experts below are selected from a list of 12669 Experts worldwide ranked by ideXlab platform
Atsushi Nambu - One of the best experts on this subject based on the ideXlab platform.
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Rib Fracture after stereotactic radiotherapy for primary lung cancer prevalence degree of clinical symptoms and risk factors
BMC Cancer, 2013Co-Authors: Atsushi Nambu, Hiroshi Onishi, Shinichi Aoki, Licht Tominaga, Kengo Kuriyama, Masayuki Araya, Ryoh Saito, Yoshiyasu Maehata, Takafumi KomiyamaAbstract:Background As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with Rib Fractures after SBRT for primary lung cancer and to reveal risk factors for Rib Fracture. Appropriate α/β ratios for discriminating between Fracture and non-Fracture groups were also investigated.
John C Mayberry - One of the best experts on this subject based on the ideXlab platform.
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Prospective clinical trial of surgical intervention for painful Rib Fracture nonunion.
American Surgeon, 2014Co-Authors: Loic Fabricant, Bruce Ham, Richard J. Mullins, John C MayberryAbstract:We performed a prospective clinical trial of resection with or without plate fixation for symptomatic Rib Fracture nonunion three or more months postinjury with 6-month postoperative followup. The McGill Pain Questionnaire (MPQ) and RAND 36 Health Survey were administered and activity level (sedentary, ambulatory, moderately active, vigorous), functional status (disabled, nonphysical labor, physical labor), and work status (employed, unemployed, retired, student) were queried pre- and postoperatively. Twenty-four patients 4 to 197 months (median, 16 months) postinjury underwent surgical intervention for one to four Rib Fracture nonunions (median, two nonunions). Evidence of intercostal nerve entrapment was present in nine patients (38%). MPQ Present Pain Intensity and Pain Rating Index and RAND 36 Physical Functioning, Role Physical, Social Functioning, Role Social, Bodily Pain, Vitality, Mental Health, and General Health were significantly improved at six months compared with study entry (P < 0.05). Activity levels significantly improved (P < 0.0001) but functional and work status did not change. Twenty-four-hour morphine equivalent dosage of opioids at study entry was 20.3 ± 30.8 (mean ± standard deviation) and at study completion was 9.4 ± 17.5 (P = 0.054). Complications included one wound infection, two partial screw backouts, and one chest wall hernia at one year after resection of adjacent nonunions with significant gaps repaired with absorbable plates. Surgical intervention for Rib Fracture nonunion may improve chronic pain and disability but without change in functional or work status. Resection of adjacent nonunions with significant gaps may lead to chest wall hernia.
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Rib Fracture fixation for flail chest what is the benefit
Journal of The American College of Surgeons, 2012Co-Authors: Akash Bhatnagar, John C Mayberry, Raminder NirulaAbstract:Background Recently, Rib Fracture fixation for flail chest has been used increasingly at both academic and nonacademic trauma centers. Although a few small non-US studies have demonstrated a clinical benefit, it is unclear whether this benefit outweighs the added expense and potential perioperative complications related to the procedure. We therefore sought to determine if open reduction and internal fixation of Ribs for flail chest (ORIF-FC) represents a cost-effective means for managing these patients. Study Design A Markov transition state analysis was performed modeling the outcomes of the standard of care or ORIF-FC for flail chest. The incidences of ventilator-associated pneumonia, tracheostomy, sepsis, prolonged ventilation, deep vein thrombosis, pulmonary embolism, wound infection, and postoperative hemorrhage were obtained based on literature review. Medicare 2010 reimbursement costs were used for diagnoses and procedures. A quality of life improvement factor ranging from 0 to 15% improvement was used to estimate the improvement in pain and functional outcomes related to ORIF-FC. The most cost-effective treatment was then determined, ranging the incidences of ventilator-associated pneumonia and quality of life improvement factor. Results Cost effectiveness was $15,269 for ORIF-FC compared with $16,810 for standard of care. Even when the quality of life improvement factor was set to 0%, ORIF-FC remained the most cost-effective strategy. Similarly, ORIF-FC remained the most cost-effective strategy by $8,400 when the incidence of ventilator-associated pneumonia after ORIF was as high as 22%. Conclusions Despite the additional cost of surgery, Rib Fracture fixation dominates the standard of care and should be considered in the management of appropriate flail chest patients.
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Traumatic Rib Fracture: Conservative Therapy or Surgical Fixation?
Difficult Decisions in Thoracic Surgery, 2010Co-Authors: John C Mayberry, Paul H. SchipperAbstract:Rib Fractures are a common problem affecting injured patients, and the vast majority of patients heal their Rib Fractures without surgical intervention. Patients with severe Rib Fracture syndromes such as flail chest, traumatic chest wall defects, or pulmonary hernias are selectively recommended for Rib Fracture fixation, but the practice is not uniform and is controversial. Proponents of operative intervention contend Rib Fracture fixation in select patients will diminish the risk of respiratory complications and improve long-term pain and disability. Skeptics argue that operative intervention is applicable to a very small subset of injured patients with severe chest wall injuries and unnecessary or meddlesome in the rest.
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Rib Fracture fixation controversies and technical challenges
American Surgeon, 2010Co-Authors: Raminder Nirula, John C MayberryAbstract:Rib Fractures are a common injury affecting more than 350,000 people each year in the United States and are associated with respiratory complications, prolonged hospitalization, prolonged pain, long-term disability, and mortality. The social and economic costs that Rib Fractures contRibute to the health care burden of the United States are therefore significant. But despite this measurable impact on patients' quality of life, current treatment of the majority of patients in the United States with Rib Fracture syndromes is supportive only. Even the most severe of chest wall injuries have historically been treated non-operatively. Recently, however, several reports from American centers support an increased application of operative fixation. With this resurgent interest of American surgeons in mind, we review the clinical presentations, potential indications, controversies, and technical challenges unique to Rib Fracture fixation.
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Rib Fracture repair: indications, technical issues, and future directions
World journal of surgery, 2008Co-Authors: Raminder Nirula, Jose J. Diaz, Donald D. Trunkey, John C MayberryAbstract:Rib Fracture repair has been performed at selected centers around the world for more than 50 years; however, the operative indications have not been established and are considered controversial. The outcome of a strictly nonoperative approach may not be optimal. Potential indications for Rib Fracture repair include flail chest, painful, movable Rib Fractures refractory to conventional pain management, chest wall deformity/defect, Rib Fracture nonunion, and during thoracotomy for other traumatic indication. Rib Fracture repair is technically challenging secondary to the human Rib's relatively thin cortex and its tendency to Fracture obliquely. Nonetheless, several effective repair systems have been developed. Future directions for progress on this important surgical problem include the development of minimally invasive techniques and the conduct of multicenter, randomized trials.
L. P. H. Leenen - One of the best experts on this subject based on the ideXlab platform.
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Surgical treatment of Rib Fracture nonunion: A single center experience.
Injury-international Journal of The Care of The Injured, 2018Co-Authors: M B De Jong, Roderick M. Houwert, S. Van Heerde, M. De Steenwinkel, Falco Hietbrink, L. P. H. LeenenAbstract:Abstract Introduction In contrast to the emerging evidence on the operative treatment of flail chest, there is a paucity of literature on the surgical treatment of Rib Fracture nonunion. The purpose of this study was to descRibe our standardized approach and report the outcome (e.g. patient satisfaction, pain and complications) after surgical treatment of a Rib Fracture nonunion. Methods A single centre retrospective cohort study was performed at a level 1 trauma centre. Symptomatic Rib nonunion was defined as a severe persistent localized pain associated with the nonunion of one or more Rib Fractures on a chest CT scan at least 3 months after the initial trauma. Patients after initial operative treatment of Rib Fractures were excluded. Results Nineteen patients (11 men, 8 women), with symptomatic nonunions were included. Fourteen patients were referred from other hospitals and 8 patients received treatment from a pain medicine specialist. The mean follow-up was 36 months. No in-hospital complications were observed. In 2 patients, new Fractures adjacent to the implant, without new trauma were observed. Furthermore 3 patients requested implant removal with a persistent nonunion in one patient. There was a mean follow-up of 36 months, the majority of patients (n = 13) were satisfied with the results of their surgical treatment and all patients experienced a reduction in the number of complaints. Persisting pain was a common complaint. Three patients reporting severe pain used opioid analgesics on a daily or weekly basis. Only 1 patient needed ongoing treatment by a pain medicine specialist. Conclusion Surgical fixation of symptomatic Rib nonunion is a safe and feasible procedure, with a low perioperative complication rate, and might be beneficial in selected symptomatic patients in the future. In our study, although the majority of patients were satisfied and the pain level subjectively decreases, complaints of persistent pain were common.
Takafumi Komiyama - One of the best experts on this subject based on the ideXlab platform.
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Rib Fracture after stereotactic radiotherapy for primary lung cancer prevalence degree of clinical symptoms and risk factors
BMC Cancer, 2013Co-Authors: Atsushi Nambu, Hiroshi Onishi, Shinichi Aoki, Licht Tominaga, Kengo Kuriyama, Masayuki Araya, Ryoh Saito, Yoshiyasu Maehata, Takafumi KomiyamaAbstract:Background As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with Rib Fractures after SBRT for primary lung cancer and to reveal risk factors for Rib Fracture. Appropriate α/β ratios for discriminating between Fracture and non-Fracture groups were also investigated.
Jeanpierre Bissonnette - One of the best experts on this subject based on the ideXlab platform.
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chest wall pain and Rib Fracture after stereotactic radiotherapy for peripheral non small cell lung cancer
Journal of Thoracic Oncology, 2009Co-Authors: Jon Paul J Voroney, Andrew Hope, Max Dahele, Thomas Purdy, Kevin N Franks, Shannon Pearson, J Cho, Alexander Y Sun, D Payne, Jeanpierre BissonnetteAbstract:Stereotactic body radiotherapy is an emerging treatment option for peripheral non-small cell lung cancer in medically inoperable patients. With high dose per fraction radiotherapy, late side effects are of possible concern. In our initial cohort of 42 patients treated with 54 to 60 Gy in three fractions, nine patients have Rib Fracture. The median dose to Rib Fracture sites was 46 to 50 Gy, depending on the method of dose calculation. We descRibe a typical case of poststereotactic radiotherapy Rib Fracture and present dosimetric analysis of patients with Rib Fracture.