801
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Nithin KU, Sridhar MG, Srilatha K, Habebullah S. CA 125 is a better marker to differentiate endometrial cancer and abnormal uterine bleeding. Afr Health Sci 2018; 18:972-978. [PMID: 30766562 PMCID: PMC6354887 DOI: 10.4314/ahs.v18i4.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Incidence of endometrial cancer in India is increasing due to lifestyle changes and obesity. As 5 year survival rate of cancer confined to uterus is good, there is need for serum tumor marker for early diagnosis. This study was designed to identify a tumor marker which differentiate endometrial carcinoma and abnormal uterine bleeding (AUB) because common presentation of endometrial carcinoma is AUB. Objectives To estimate and compare serum prolactin, Cancer Antigen 125 (CA-125), Cancer Antigen 15-3 (CA15-3), and Carcino embryonic antigen (CEA) levels in patients with endometrial cancer and abnormal uterine bleeding; To evaluate the role of these markers in diagnosing endometrial cancer. Methodology Thirty eight patients with endometrial cancer and 40 patients with AUB were recruited in this study. Serum prolactin, CA 125, CEA, and CA 15-3 levels were estimated in both groups. Results The levels of CA 15-3, CA 125, CEA, and prolactin were increased in endometrial carcinoma patients, on comparison with AUB patients. CA 125 alone was found to be a better marker to detect endometrial cancer with 52.63% sensitivity, 80.00% specificity. Conclusion As individual tumor marker, serum CA 125 has the ability to detect endometrial cancer in patients with abnormal uterine bleeding.
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Affiliation(s)
| | | | | | - S Habebullah
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Post graduate Medical Education and Research, Puducherry - 605006
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802
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Femoral neck fractures after internal fixation of trochanteric fractures with implants in situ in adults: A systematic review. Injury 2018; 49:2121-2131. [PMID: 30526921 DOI: 10.1016/j.injury.2018.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral neck fractures (FNF) after internal fixation of trochanteric fractures (AIFTF) with the implant in situ (WIIS) are uncommon. Publications of FNFAIFTFWIIS are rare. The purpose of this systematic review of the literature is to report on the frequency, risk factors, mechanisms, clinical presentation, diagnostic and therapeutic modalities, outcomes and the eventual prevention of this complication. MATERIALS AND METHODS A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of FNFAIFTFWIIS and series of trochanteric fractures (TF) with this complication in adults published between inception of journals to May 2018 were eligible for inclusion. Cases with fractures in pathological bone, undergoing treatment with hip replacement, or after partial or total implant removal were excluded. Relevant information was divided in two parts. Part I included the analysis of cases of FNFAIFTFWIIS, with the objective of establishing the eventual risk factors, mechanisms, diagnostic, treatment modalities, and outcomes. Part II analyzed series of TFs with implants in situ which included cases of FNFs for assessing the incidence of FNFs in this condition. RESULTS Overall 77 publications with 104 cases of FNFAIFTFWIIS met the inclusion criteria. The median incidence of this complication was 0,43%. The mean age was 80 years (range, 42-96).The prevalent factors for FNFAIFTFWIIS were osteoporosis, and the presence of the implant in the femoral neck and head. A short nail or screw with the tip far from the subchondral bone was of influence as a stress riser factor, but not prevalent because in two thirds of the cases the FNF occurred when the implant was introduced up to the subchondral bone. Other risk factors analysed included varus reduction or nonunion of the TF, and the breakage of the hip screw, which modify the forces exerted over the femoral neck, and may contribute to the FNF. The FNFs were spontaneous, i.e. not related to trauma or fall, in more than two thirds of the cases. CONCLUSION The etiology of FNFAIFTFWII should be considered multifactorial. The frequency seems low. Although a subchondral positioning of the hip screw might diminish the incidence of FNFS, a correct surgical technique does not preclude a FNFAIFTFWIIS, and in fact the incidence of this complication was higher in these correctly treated patients. FNFAIFTFWIIS is a fragility fracture and adequate management of systemic osteoporosis should be targeted as a main factor of prevention.
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803
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Ding T, Zhang B, Tian S, Wang Y, Sun K. [Selection principles and application status of surgical methods for hip fracture in the elderly]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1435-1440. [PMID: 30417620 PMCID: PMC8414111 DOI: 10.7507/1002-1892.201804084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/08/2018] [Indexed: 11/03/2022]
Abstract
Objective To summarize the selection criteria and clinical application of surgical methods for hip fractures (femoral neck fracture and intertrochanteric fracture) in the elderly. Methods The related literature concerning the surgical methods for femoral neck fracture and intertrochanteric fracture in the elderly at home and abroad was extensively reviewed and summarized. Results Among the elderly patients with femoral neck fracture, the closed reduction and internal fixation or dynamic hip screw (DHS), and total hip arthroplasty are recommended for patients under 65 years old and 65-80 years old respectively and without special surgical contraindication; whereas hemiarthroplasty is recommended for patients with poor physical conditions. Among the patients with intertrochanteric fracture, DHS or the 3rd generation of Gamma nails is recommended for patients with stable fracture while the intramedullary fixation systems (e.g., proximal femoral nail anti-rotation, intertrochanteric antegrade nail) and the extramedullary fixation systems (e.g., proximal femoral locking compression plate and less invasive stabilization system) can be applied to the patients with unstable fracture according to the fracture type and bone conditions. Notably, hip arthroplasty is recommended for elderly patients with comminuted fracture. Conclusion The surgical method and internal fixator should be chosen according to the fracture type and bone condition in the elderly in order to improve the effectiveness and reduce the complication.
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Affiliation(s)
- Tao Ding
- Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555, P.R.China
| | - Baokun Zhang
- Department of Trauma Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, P.R.China
| | - Shaoqi Tian
- Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555, P.R.China
| | - Yuanhe Wang
- Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555, P.R.China
| | - Kang Sun
- Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555,
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804
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Trajectory Modelling to Assess Trends in Long-Term Readmission Rate among Abdominal Aortic Aneurysm Patients. Surg Res Pract 2018; 2018:4321986. [PMID: 30420971 PMCID: PMC6215543 DOI: 10.1155/2018/4321986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate. Results Based on the trends in readmission rates, GBTM classified elective AAA repair (n=16,973) patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex (P=0.001) undergoing other vascular procedures (P=0.003), poor socioeconomic status index (P < 0.001), older age (P < 0.001), and higher comorbidity score (P < 0.001). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair (n=4144) had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (P < 0.001), heart failure (P = 0.01), peripheral vascular disease (P < 0.001), female sex (P = 0.02), open repair (P < 0.001), and undergoing other related procedures (P=0.05). The AUC for c-statistics was 0.71. Conclusion Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbidities perioperatively and during their follow-up.
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805
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Geberemariyam BS, Donka GM, Wordofa B. Assessment of knowledge and practices of healthcare workers towards infection prevention and associated factors in healthcare facilities of West Arsi District, Southeast Ethiopia: a facility-based cross-sectional study. ACTA ACUST UNITED AC 2018; 76:69. [PMID: 30455882 PMCID: PMC6231270 DOI: 10.1186/s13690-018-0314-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Abstract
Background The prevention of healthcare associated infections is central to the provision of safe, high quality healthcare. Infections acquired in healthcare facilities are a major public health concern, contributing to increased morbidity, mortality, and cost in both developed and developing countries. Although most of these infections can be prevented with relatively inexpensive infection prevention and control measures in many developing countries, in sub-Saharan African healthcare facilities have no effective infection prevention programs. Additionally, there is limited information on healthcare worker infection prevention knowledge and practice in countries such as Ethiopia. The aim of this study was to assess the knowledge and practices of healthcare workers with respect to infection prevention and associated factors in healthcare facilities in southeast Ethiopia. Methods A facility-based cross-sectional study design was used to study healthcare workers in the southeast, Ethiopia. Multi-stage sampling was employed to select 680 healthcare workers from 30 randomly selected healthcare facilities. Data was collected using a self-administered structured questionnaire. Descriptive statistics were computed. Multivariable logistic regression was performed to identify factors associated with healthcare workers infection prevention knowledge and practice. Results A total of 648 healthcare workers participated in this study, for a response rate of 95.3%. Of these, 53.7% (95% CI: 49.8, 57.4%) and 36.3% (95% CI: 32.4, 40.1%) of the respondents were assessed as knowledgeable and reported safe infection prevention practices respectively. The likelihood of self-reporting safe infection prevention practice significantly increased if healthcare workers had received training (AOR = 5.31; 95% CI: 2.42,11.63) and had infection prevention guidelines available (AOR = 3.34; 95% CI: 1.65, 6.76). Healthcare workers were more likely to have infection prevention knowledge if they worked longer ten years or more (AOR = 3.41; 95% CI: 1.22, 9.55); worked in facilities with infection prevention committees (AOR = 1.78; 95% CI: 1.01, 3.13), had infection prevention guidelines available (AOR = 2.44; 95% CI: 1.45, 4.12); had training (AOR = 5.02; 95% CI: 1.45, 8.59). Conclusions Inadequate infection prevention knowledge and unsafe practices were frequent among study participants, reflecting a potentially common problem at public healthcare facilities in southeast Ethiopia. Healthcare workers have better knowledge and safer practices if they had received infection prevention training and had infection prevention guidelines in their workplace. Interventions should be designed to consider these identified factors.
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Affiliation(s)
| | - Geroma Morka Donka
- Department of Nursing, School of Health Science, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Berhanu Wordofa
- 3Department of Nursing and Midwifery, School of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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806
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Çalışkan S, Türkmen M, Sungur M. Inguinal Bladder Hernia in Female Patient. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:671-672. [PMID: 30510346 PMCID: PMC6230932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Selahattin Çalışkan
- Department of Urology, Kanuni Sultan Süleyman Training and Research Hospital, Health Sciences University, İstanbul, Turkey
| | - Musa Türkmen
- Department of Surgery, Çorum Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Mustafa Sungur
- Department of Urology, Çorum Training and Research Hospital, Hitit University, Çorum, Turkey
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807
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Adegbiji WA, Olajide GT, Olatoke F, Ogundipe OK, Alabi SB. The Role of Preoperative Evaluations in Otorhinolaryngological Procedures. Niger Med J 2018; 59:59-63. [PMID: 31423043 PMCID: PMC6668303 DOI: 10.4103/nmj.nmj_183_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Routine laboratory investigations are important in preoperative preparation of otorhinolaryngological, head and neck patients to assess and to prevent operative risks. This study aimed at determining the American Society of Anesthesiologist (ASA) classification of the preoperative patients, causes of delayed surgery, associated comorbidity and abnormal laboratory investigation results in ear, nose, and throat surgical practice in a low-resource setting. MATERIALS AND METHODS This is a prospective hospital-based study of patients being worked up for elective surgical procedures in Ekiti State University Teaching Hospital, Nigeria, from January 2014 to December 2016. Patients that gave consent were enrolled into the study. Interviewer-assisted questionnaires were used to obtained data from the patients. Data obtained were collated and statistically analyzed by using SPSS version 16. RESULTS A total of 424 patients were enrolled into the study. Males constituted 61.8% and male to female ratio was 2:1. Majority, i.e. 69.8% of the patients belonged to the ASA Grade I. Preoperative findings leading to delayed surgery occurred in 17.9% of the patients. They were due to 2.4% arterial hypertension and 6.4% delayed routine laboratory investigations results. The overall comorbid illness was 21.2%. Major comorbid illnesses were 2.4% arterial hypertension and 6.8% diabetes mellitus. The types of surgery in the patients were 14.6% ear surgery, 12.3% nasal surgery, and 59.2% throat surgery. Delayed surgery occurred in 25.5% of the patients. The most common findings were 6.8% anemia, 6.3% abnormal prothrombin/international normalized ratio, and 5.7% blood electrolyte and urea. CONCLUSION All surgical conditions are peculiar with different comorbid illnesses which can lead to untoward outcome. Adequate preoperative evaluation and preoperative laboratory investigation of ear, nose, and throat conditions are mandatory to detect subclinical illnesses in poor-resource setting.
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Affiliation(s)
- Waheed Atilade Adegbiji
- Department of Ear, Nose and Throat Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Gabriel Toye Olajide
- Department of Ear, Nose and Throat, Federal Teaching Hospital, Ido Ekiti/Afe Babalola University College of Medicine and Health Sciences, Ado Ekiti, Nigeria
| | - Fatai Olatoke
- Department of Surgery, ENT Unit, Federal Medical Center, Lokoja, Nigeria
| | | | - Sulyman Biodun Alabi
- Department of Ear, Nose and Throat, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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808
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Liu S, Wang Y, Kotian RN, Li H, Mi Y, Zhang Y, He X. Comparison of Nonabsorbable and Absorbable Suture in Total Knee Arthroplasty. Med Sci Monit 2018; 24:7563-7569. [PMID: 30350827 PMCID: PMC6354634 DOI: 10.12659/msm.910785] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Wound closure of KA is important for postoperative rehabilitation. At present there is still no consensus on the best wound closure technique for KA. We performed the present study to determine whether absorbable suture is better than nonabsorbable suture in total knee arthroplasty (TKA). Material/Methods A total of 180 patients who underwent TKA were divided into 3 groups: 80 cases of nonabsorbable suture, 50 cases of 2-0 absorbable suture, and 50 cases of 4-0 absorbable suture. The time required for closure, frequency of gauze change, length of stay in hospital, adverse events, range of motion (ROM) after 3 months postoperatively, and VAS score of wounds were calculated. Comparison was made to explore any significant differences between different groups. Results There were significant differences between the nonabsorbable group and the absorbable group with regards to closure time, frequency of gauze change, and hospital length of stay (LOS). Closure time was longer in the absorbable group than in the nonabsorbable group. Frequency of gauze change, hospital LOS, and adverse events were lower, and VAS was higher in the absorbable group. Closure time was longer in the 4-0 absorbable group than in the 2-0 group. There was no significant difference between the 4-0 group and 2-0 group in other variables. There was no significant difference in long-term ROM among all groups. Conclusions Absorbable suture in TKA reduces the incidence of fatty liquefaction, frequency of gauze change, and postoperative LOS. It improves the cosmetic appearance and overall reduces the economic cost. There was no significant effect on early and long-term functional ROM. In conclusion, absorbable suture can be used in TKA when appropriately indicated.
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Affiliation(s)
- Shuguang Liu
- Department of Orthopedics, Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland).,Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Yunmei Wang
- Department of Medical Oncology, Shaanxi Provincial Cancer Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Ronak N Kotian
- Department of Orthopedics, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Hui Li
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Yufei Mi
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland).,Department of Orthopedics, Orthopedic Hospital of Henan Province, Luoyang, Henan, China (mainland)
| | - Yumin Zhang
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Xijing He
- Department of Orthopedics, Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
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809
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Alhashemi M, Fiore JF, Safa N, Al Mahroos M, Mata J, Pecorelli N, Baldini G, Dendukuri N, Stein BL, Liberman AS, Charlebois P, Carli F, Feldman LS. Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway. Surg Endosc 2018; 33:2313-2322. [PMID: 30334165 DOI: 10.1007/s00464-018-6514-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prolonged postoperative ileus (PPOI) is common after colorectal surgery but has not been widely studied in the context of enhanced recovery pathways (ERPs) that include interventions aimed to accelerate gastrointestinal recovery. The aim of this study is to estimate the incidence and predictors of PPOI in the context of an ERP for colorectal surgery. METHODS We analyzed data from an institutional colorectal surgery ERP registry. Incidence of PPOI was estimated according to a definition adapted from Vather (intolerance of solid food and absence of flatus or bowel movement for ≥ 4 days) and compared to other definitions in the literature. Potential risk factors for PPOI were identified from previous studies, and their predictive ability was evaluated using Bayesian model averaging (BMA). Results are presented as posterior effect probability (PEP). Evidence of association was categorized as: no evidence (PEP < 50%), weak evidence (50-75%), positive evidence (75-95%), strong evidence (95-99%), and very strong evidence (> 99%). RESULTS There were 323 patients analyzed (mean age 63.5 years, 51% males, 74% laparoscopic, 33% rectal resection). The incidence of PPOI was 19% according to the primary definition, but varied between 11 and 59% when using other definitions. On BMA analysis, intraoperative blood loss (PEP 99%; very strong evidence), administration of any intravenous opioids in the first 48 h (PEP 94%; strong evidence), postoperative epidural analgesia (PEP 56%; weak evidence), and non-compliance with intra-operative fluid management protocols (3 ml/kg/h for laparoscopic and 5 ml/kg/h for open; PEP 55%, weak evidence) were predictors of PPOI. CONCLUSIONS The incidence of PPOI after colorectal surgery is high even within an established ERP and varied considerably by diagnostic criteria, highlighting the need for a consensus definition. The use of intravenous opioids is a modifiable strong predictor of PPOI within an ERP, while the role of epidural analgesia and intraoperative fluid management should be further evaluated.
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Affiliation(s)
- Mohsen Alhashemi
- Department of Surgery, McGill University Health Centre, Montreal, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University Health Centre, Montreal, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Nadia Safa
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Mohammed Al Mahroos
- Department of Surgery, McGill University Health Centre, Montreal, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Juan Mata
- Department of Surgery, McGill University Health Centre, Montreal, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Nicolò Pecorelli
- Department of Surgery, McGill University Health Centre, Montreal, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Gabriele Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal, Canada
| | - Nandini Dendukuri
- Department of Clinical Epidemiology, McGill University Health Centre - Research Institute, Montreal, QC, Canada
| | - Barry L Stein
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - A Sender Liberman
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Patrick Charlebois
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, Canada. .,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada. .,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, H3G1A4, Canada.
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810
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Rondelli F, De Rosa M, Stella P, Boni M, Ceccarelli G, Balzarotti R, Polistena A, Sanguinetti A, Bugiantella W, Avenia N. Perforated vs. nonperforated acute appendicitis: evaluation of short-term surgical outcomes in an elderly population. MINERVA CHIR 2018; 74:374-378. [PMID: 30306768 DOI: 10.23736/s0026-4733.18.07715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute appendicitis is a common acute surgical abdominal condition and despite the majority of cases are observed in children and young adults, its occurrence in the elderly seems to be increasing, with a higher risk of perforation. The aim of this study was to evaluate the surgical outcomes following appendectomy for acute appendicitis in the elderly, making a comparison between perforated and nonperforated groups regarding operative time, hospital stay and postoperative complications. METHODS The medical records of 48 patients over the age of 60 years who had a pathologically confirmed diagnosis of acute appendicitis from January 2011 to December 2016 were retrospectively reviewed. Patients were grouped into those with perforated and those with non-perforated appendicitis (NPA) and a comparison was made between both groups regarding demography, operative time, length of hospital stay and postoperative complications. RESULTS From 48 patients over 60 years diagnosed with acute appendicitis, a PA was removed from 10 patients (20.8%). The PA group consisted of 3 males and 7 females, and their mean age was 71.6 years (range 65-84). The NPA group included 22 males and 16 females, and their mean age was 76.5 years (range 63-96). The mean operative time was 58±18.7 minutes and 43.3±9.9 minutes in the perforated and nonperforated groups respectively, with statistically significant difference (P=0.0013). The mean length of hospital stay was similar in the PA group and in the NPA group, being 6.5±1.8 days and 5.4±1.8 days respectively, but these differences were not statistically significant (P=0.093). The frequency of postoperative complications was similar in both groups as they were observed in 3 patients (30%) of the PA group and 10 patients (26%) of the NPA group (P=0.2488). No postoperative intraabdominal abscess was observed in both groups and there was no death after the surgery. CONCLUSIONS PA, despite requiring a longer mean operative time, in our series is not producing a longer hospital stay or more postoperative complications compared to NPA. The non-operative management of uncomplicated appendicitis is a reasonable option in frail patients in order to avoid the burden of morbidity related to operation, nevertheless surgery remains the standard of care in all age groups.
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Affiliation(s)
- Fabio Rondelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Michele De Rosa
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy -
| | - Paolo Stella
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Marcello Boni
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Graziano Ceccarelli
- Unit of Minimally Invasive and General Surgery, Department of Medicine and General Surgery, "San Donato" Hospital, ASL 8 Arezzo, Arezzo, Italy
| | - Ruben Balzarotti
- Department of General and Visceral Surgery, Civico Hospital, Lugano, Switzerland
| | - Andrea Polistena
- Unit of Endocrine Surgery, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy
| | - Alessandro Sanguinetti
- Unit of Endocrine Surgery, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy
| | - Walter Bugiantella
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Nicola Avenia
- Unit of Endocrine Surgery, Medical School, S. Maria University Hospital, University of Perugia, Terni, Italy
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811
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Boet S, Etherington N, Larrigan S, Yin L, Khan H, Sullivan K, Jung JJ, Grantcharov TP. Measuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties. BMJ Qual Saf 2018; 28:327-337. [PMID: 30309910 DOI: 10.1136/bmjqs-2018-008260] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations. METHODS Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017). Studies evaluating the measurement properties of teamwork assessment tools for teams in clinical or simulated crisis situations were included. Two independent reviewers screened studies based on predetermined criteria and completed data extraction. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS The search yielded 1822 references. Twenty studies were included, representing 13 assessment tools. Tools were primarily assessed in simulated resuscitation scenarios for emergency department teams. The Team Emergency Assessment Measure (TEAM) had the most validation studies (n=5), which demonstrated three sources of validity (content, construct and concurrent) and three sources of reliability (internal consistency, inter-rater reliability and test-retest reliability). Most studies of TEAM's measurement properties were at no risk of bias. CONCLUSIONS A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user's context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.
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Affiliation(s)
- Sylvain Boet
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nicole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sarah Larrigan
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Li Yin
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Hira Khan
- Department of Health Sciences, Faculty of Science , Carleton University, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - James J Jung
- Division of General Surgery, St. Michael's Hospital, Toronto, Canada
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812
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Perioperative insulin therapy. ASIAN BIOMED 2018. [DOI: 10.1515/abm-2018-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Surgical patients commonly develop hyperglycemia secondary to the neuroendocrine stress response. Insulin treatment of hyperglycemia is required to overcome the perioperative catabolic state and acute insulin resistance. Besides its metabolic actions on glucose metabolism, insulin also displays nonmetabolic physiological effects. Preoperative glycemic assessment, maintenance of normoglycemia, and avoidance of glucose variability are paramount to optimize surgical outcomes. This review discusses the basic physiology and effects of insulin as well as practical issues pertaining to its management during the perioperative period.
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813
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Longitudinal Kinematic Evaluation of Pharyngeal Swallowing Impairment in Thyroidectomy Patients. Dysphagia 2018; 34:161-169. [PMID: 30298382 DOI: 10.1007/s00455-018-9949-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study was to assess pharyngeal swallowing impairments in thyroidectomy patients and to delineate the contributory kinematic components. Forty consecutive patients (mean age = 47.33 years) and fourteen age- and sex-matched heathy adult volunteers (mean age = 42.64 years) participated in this study. A videofluoroscopic swallowing study (VFSS) was performed 1 day prior to surgery, and at 1 week and 3 months post-surgery. VFSS images were evaluated using the Modified Barium Swallowing Impairment Profile (MBSImp). Kinematic and temporal aspects of swallowing were characterized by measurement of maximum hyoid and laryngeal excursion, pharyngeal transit duration, laryngeal response duration (LRD), and laryngeal closure duration at each three time-points. At 1 week post-surgery, only pharyngeal impairment was significantly deteriorated than pre-surgery (p = 0.001). However, at 3 months, a significant improvement was observed to pre-surgery level (p = 0.01). Post-surgery, maximum hyoid excursion was significantly reduced in patients compared controls (p = 0.001). Although the maximal distance of the hyoid and the laryngeal excursion was shorter than before surgery, laryngeal excursion at all three time-points was similar to that of controls. At all three time-points, LRD was significantly longer in patients than in controls (p = 0.01). Following thyroidectomy, pharyngeal aspects of swallowing as measured by the MBSImp and kinematic aspects of swallowing were reduced with incomplete recovery at 3 months. These exploratory data may guide decision regarding management of pharyngeal swallowing impairment with patients undergoing total thyroidectomy.
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814
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Tantarattanapong S, Arwae N. Risk factors associated with perforated acute appendicitis in geriatric emergency patients. Open Access Emerg Med 2018; 10:129-134. [PMID: 30323692 PMCID: PMC6174914 DOI: 10.2147/oaem.s173930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to identify factors associated with perforated acute appendicitis in geriatric patients at the emergency department (ED). Patients and methods The medical records of 223 consecutive patients aged >60 years with acute appendicitis between 2006 and 2017 were retrospectively reviewed. Patients were grouped into those with perforated and non-perforated appendicitis. A comparison was made between the two groups in regard to baseline characteristics, clinical presentation, physical examination, time from onset of symptoms to ED arrival, time from ED arrival to operation, postoperative complications, hospital length of stay, and mortality. Significant factors associated with perforated appendicitis were examined using univariate and multivariate analyses by logistic regression. Results A total of 78 (35%) patients had perforated appendicitis. Four significant factors associated with perforated appendicitis were as follows: 1) time duration from onset of symptoms to ED arrival >24 hours (OR 2.49, CI 1.33–4.68); 2) heart rate ≥90 beats/minute (OR 1.93, CI 1.04–3.59); 3) respiratory rate ≥20 breaths/minute (OR 2.54, CI 1.33–4.84); and 4) generalized guarding (OR 12.58, CI 1.43–110.85). Conclusion Time duration from onset of symptoms to ED arrival >24 hours, heart rate ≥90 beats/minute, respiratory rate ≥20 breaths/minute, and generalized guarding were the significant factors associated with perforated acute appendicitis in geriatric patients.
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Affiliation(s)
- Siriwimon Tantarattanapong
- Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,
| | - Nuraianee Arwae
- Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,
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815
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Deress T, Hassen F, Adane K, Tsegaye A. Assessment of Knowledge, Attitude, and Practice about Biomedical Waste Management and Associated Factors among the Healthcare Professionals at Debre Markos Town Healthcare Facilities, Northwest Ethiopia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:7672981. [PMID: 30386382 PMCID: PMC6189693 DOI: 10.1155/2018/7672981] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/31/2018] [Accepted: 07/05/2018] [Indexed: 12/04/2022]
Abstract
Background Healthcare activities restore health and save lives at the same time; however, they can generate hazardous biomedical wastes to a human being or the environment. Generation and disposal of biomedical wastes have become an emerging problem worldwide. Objective To assess knowledge, attitude, and practice about biomedical waste management and associated factors among healthcare professionals in Debre Markos town healthcare facilities, northwest Ethiopia. Methods A cross-sectional study was employed, and data were collected through structured self-administered questionnaire and observational checklist. Data were entered into the Epi-data 3.1 software and exported into SPSS version 20 for analysis. Bivariate and multivariate logistic regression analyses were computed. Variables with a P value of <0.05 in the multivariate logistic regression analysis were considered to explain the presence of statistically significant associations. Result Among 296 healthcare professionals studied, 168 (56.8%), 196 (66.2%), and 229 (77.4%) had adequate knowledge, favorable attitude, and adequate practice score, respectively. Regarding associated factors, MSc and MD+ (AOR: 4, 95% CI: (1.37, 149.52)), BSc holders (AOR: 2.53, 95% CI: (1.47, 4.38)), and availability of color-coded bins (AOR: 7.68, 95% CI: (3.30, 17.89)) were identified more likely to contribute for adequate knowledge, favorable attitude, and adequate practice scores, respectively. Conclusion The level of knowledge, attitude, and practice scores were not satisfactory. Majority of the healthcare professionals did not access biomedical waste management training. Educational level, use of visual aid, and availability of color-coded bins in the department were identified as a factor for biomedical waste management. Regular training should be given to healthcare professionals.
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Affiliation(s)
- Teshiwal Deress
- Unit of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Fatuma Hassen
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kasaw Adane
- Unit of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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816
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Serum FABP4 concentrations decrease after Roux-en-Y gastric bypass but not after intensive medical management. Surgery 2018; 165:571-578. [PMID: 30287050 DOI: 10.1016/j.surg.2018.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Serum concentrations of fatty acid binding protein 4, an adipose tissue fatty acid chaperone, have been correlated with insulin resistance and cardiovascular risk factors. The objective of this study were to assess relationships among Roux-en-Y gastric bypass, intensive lifestyle modification and medical management protocol, fatty acid binding protein 4, and metabolic parameters in obese patients with severe type 2 diabetes mellitus; and to evaluate the relative contribution of abdominal subcutaneous adipose and visceral adipose to the secretion of fatty acid binding protein 4. METHODS Participants were randomly assigned to intensive lifestyle modification and medical management protocol (n = 29) or to intensive lifestyle modification and medical management protocol augmented with Roux-en-Y gastric bypass (n = 34). Relationships among fatty acid binding protein 4 and demographic characteristics, metabolic parameters, and 12-month changes in these values were examined. Visceral and subcutaneous adipose tissue explants from obese nondiabetic patients (n = 5) were obtained and treated with forskolin to evaluate relative secretion of fatty acid binding protein 4 in the different adipose tissue depots. RESULTS The intensive lifestyle modification and medical management protocol and Roux-en-Y gastric bypass cohorts had similar fasting serum fatty acid binding protein 4 concentrations at baseline. At 1 year, mean serum fatty acid binding protein 4 decreased by 42% in Roux-en-Y gastric bypass participants (P = .002) but did not change significantly in the intensive lifestyle modification and medical management protocol cohort. Percentage of weight change was not a significant predictor of 12-month fatty acid binding protein 4 within treatment arm or in multivariate models adjusted for treatment arm. In adipose tissue explants, fatty acid binding protein 4 was secreted similarly between visceral and subcutaneous adipose tissue. CONCLUSION After Roux-en-Y gastric bypass, fatty acid binding protein 4 is reduced 12 months after surgery but not after intensive lifestyle modification and medical management protocol in patients with type 2 diabetes mellitus. Fatty acid binding protein 4 was secreted similarly between subcutaneous and visceral adipose tissue explants.
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817
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Dhawan R, Singh RA, Tins B, Hay SM. Sternoclavicular joint. Shoulder Elbow 2018; 10:296-305. [PMID: 30214497 PMCID: PMC6134528 DOI: 10.1177/1758573218756880] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 12/16/2022]
Abstract
The sternoclavicular joint is a saddle shaped, synovial joint and is the only skeletal articulation between the axial skeleton and the upper limb. Here, a reviewis provided of the anatomy, biomechanics, traumatic and atraumatic conditions, and management options for the various conditions described.
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Affiliation(s)
- Rohit Dhawan
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK,Rohit Dhawan, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, SY10 7AG, UK.
| | - Rohit Amol Singh
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK
| | - Bernhard Tins
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK
| | - Stuart M. Hay
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK,Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK
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818
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Matinyi S, Enoch M, Akia D, Byaruhanga V, Masereka E, Ekeu I, Atuheire C. Contamination of microbial pathogens and their antimicrobial pattern in operating theatres of peri-urban eastern Uganda: a cross-sectional study. BMC Infect Dis 2018; 18:460. [PMID: 30200891 PMCID: PMC6131813 DOI: 10.1186/s12879-018-3374-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microbial contamination of hospital environment, especially in operating theatres (OT) and other specialized units has greatly contributed to continuous and multiple exposure to nosocomial infections by patients and the public. We purposed to assess microbial contamination of operating theatres and antibacterial sensitivity pattern of bacteria isolated from theatres of Mbale Regional Referral Hospital, Eastern Uganda. METHODS We employed a laboratory based cross-sectional study design. Swabbing of different surfaces and settle plate establishment in 4 various operating theatres was carried out. A total of 109 samples were collected, 31 air samples and 78 swabs from four operating theatres. Samples were collected in the mornings after disinfection prior to start of daily operations. Antibacterial sensitivity testing of isolated bacterial pathogens was performed by Kirby Bauer disc diffusion method following standard operating procedure. Colony counts for the settle plates were carried out using a colony counter. RESULTS All the four theatres had their mean colony counts exceeding the acceptable limit of 5 cfu/dm2/h. Gynaecology theatre had up to 261 cfu/dm2/h and Ophthalmology operating theatre had approximately 43 cfu/dm2/h. A total of 14 different organisms were isolated with Pseudomonas spp. [23.9%]; Bacillus spp. [17.5%] and Aspergillus spp. [15.8%] being the most common contaminants respectively. Other isolates included Enterococcus spp., Rhizopus spp. and Coagulate Negative Staphylococcus isolates especially from settle plates. Most bacterial isolates showed considerable resistance to antibacterial agents. Pseudomonas spp. was resistant to chloramphenicol (53.6%) and cotrimoxazole (57.1%). Most of the bacterial pathogens were sensitive to imipenem [83.3%]. CONCLUSIONS There is moderate contamination of operating theatres of Mbale Regional Referral Hospital. Common organisms were Pseudomonas, Bacillus, and Aspergillus spps. Resistance was observed against chloramphenicol and cotrimoxazole. More caution is necessary to carefully disinfect the operating theatres at Regional referral settings and similar tertiary health care centres with more emphasis on obstetrics and gynecology theatres. Diagnosis and care of patients at such clinical settings should consider the possibility of antibiotic resistance.
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Affiliation(s)
- Sandra Matinyi
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Muwanguzi Enoch
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Deborah Akia
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Valentine Byaruhanga
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Edson Masereka
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Isaac Ekeu
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Collins Atuheire
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, P.O Box 7076, Uganda
- Department of Public Health, School of Allied Health Sciences, Kampala International University, Western Campus, Bushenyi, Uganda
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819
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Are Incidental Gallbladder Cancers Missed with a Selective Approach of Gallbladder Histology at Cholecystectomy? World J Surg 2018; 42:1092-1099. [PMID: 28900706 PMCID: PMC5843671 DOI: 10.1007/s00268-017-4215-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidental gallbladder cancer (IGBC) is an unexpected finding when a cholecystectomy is performed upon a benign indication, and the use of routine or selective histological analysis of gallbladder specimen is still debated. The aim of this study was to investigate whether the proportion of submitted gallbladder specimens for pathological investigation influences the proportion of IGBC found, and what possible factors preoperatively or perioperatively could influence the selection process. METHODS All cholecystectomies between January 2007 and September 2014 registered in the Swedish Registry of Gallstone Surgery and ERCP (GallRiks) were included. Proportion of histological analysis was divided into four subgroups (0-25%, >25-50%, >50-75%, >75-100%). RESULTS A total of 81,349 cholecystectomies were registered, and 36,010 (44.3%) gallbladder specimens were sent for histological analysis. A total of 213 cases of IGBC were discovered, which constituted 0.26% of all cholecystectomies performed and 0.59% of the number of gallbladder specimens sent for histological analysis. Hospitals submitting >75-100% of the gallbladder specimens had significantly more IGBC/1000 cholecystectomies performed (p = 0.003). Hospitals with the most selective approach had a significantly higher proportion of IGBC/1000 gallbladders that were sent for histological analysis (p < 0.001). Factors such as higher age (p < 0.001), female gender (p = 0.048) and macroscopic cholecystitis (p < 0.001) were more common in gallbladder specimens from hospitals that had a selective approach to histological analysis. CONCLUSION A routine approach to histological analysis in cholecystectomies with a benign indication for surgery can uncover a higher proportion of IGBC cases. When a selective approach is used, risk factors should be taken into account.
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820
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Di Capua J, Lugo-Fagundo N, Somani S, Kim JS, Phan K, Lee NJ, Kothari P, Vig KS, Cho SK. Diabetes Mellitus as a Risk Factor for Acute Postoperative Complications Following Elective Adult Spinal Deformity Surgery. Global Spine J 2018; 8:615-621. [PMID: 30202716 PMCID: PMC6125929 DOI: 10.1177/2192568218761361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Diabetes mellitus is a highly prevalent disease in the United States. Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. Considering utilization of spinal surgery will continue to increase, this study investigates the influence of diabetes mellitus on acute postoperative outcomes following elective ASD surgery. METHODS The 2010-2014 American College of Surgeon's National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases (9th Revision) diagnosis codes relevant to ASD surgery. Patients were divided into cohorts based on their diabetic status. Bivariate and multivariate logistic regression analyses were employed to identify which 30-day postoperative outcomes patients are at risk for. RESULTS A total of 5809 patients met the inclusion criteria for the study of which 4553 (84.2%) patients were nondiabetic, 578 (10.7%) patients had non-insulin-dependent diabetes mellitus (NIDDM), and 275 (5.1%) patients had insulin-dependent diabetes mellitus (IDDM). Diabetes status was significantly associated with length of stay ≥5 days (NIDDM: odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.02-1.58, P = .034; IDDM: OR = 1.55, 95% CI = 1.15-2.09, P = .004), any complication (NIDDM: OR = 1.26, 95% CI = 1.01-1.58, P = .037), urinary tract infection (NIDDM: OR = 1.87, 95% CI = 1.14-3.05, P = .012), and cardiac complications (IDDM: OR = 4.05, 95% CI = 1.72-9.51, P = .001). CONCLUSIONS Given the prevalence of diabetes, surgeons will invariably encounter these patients for ASD surgery. The present study identifies the increased risk NIDDM and IDDM patients experience following ASD surgery. Quantification of this increased risk may improve the selection of appropriate surgical candidates, patient risk stratification, and patient postoperative safety.
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Affiliation(s)
- John Di Capua
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Phan
- University of New South Wales, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Nathan J. Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parth Kothari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Samuel K. Cho, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
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821
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Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings. Gastroenterol Res Pract 2018; 2018:1937416. [PMID: 30224915 PMCID: PMC6129792 DOI: 10.1155/2018/1937416] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/21/2018] [Accepted: 07/08/2018] [Indexed: 12/13/2022] Open
Abstract
Background The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required. Aims and Methods This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016). Results The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m2, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss (p = 0.006) and a long-standing presentation (more than six months in 80% of patients) (p = 0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A “resembling postprandial distress syndrome dyspepsia” presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome (p = 0.02). The narrowing of both the aortomesenteric angle (p = 0.001) and the aortomesenteric distance (p < 0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle. Conclusion SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.
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822
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Edwin J, Ahmed S, Verma S, Tytherleigh-Strong G, Karuppaiah K, Sinha J. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Rev 2018; 3:471-484. [PMID: 30237905 PMCID: PMC6134883 DOI: 10.1302/2058-5241.3.170078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints. This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich’s disease and Tietze syndrome. The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions.
Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078
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Affiliation(s)
| | - Shahbaz Ahmed
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
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823
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Tatli F, Gozeneli O, Uyanikoglu H, Uzunkoy A, Yalcın HC, Ozgonul A, Bardakci O, Incebiyik A, Guldur ME. The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women. Bosn J Basic Med Sci 2018; 18:275-278. [PMID: 29285999 PMCID: PMC6087557 DOI: 10.17305/bjbms.2018.2659] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/23/2017] [Accepted: 12/23/2017] [Indexed: 01/21/2023] Open
Abstract
Scar endometriosis, also referred to as abdominal wall endometriosis (AWE), is a rare form of endometriosis that usually develops in the scar after obstetric or gynecological surgeries, including cesarean section (CS). Recently, the occurrence of scar endometriosis has been increasing together with the increase of CS incidence. Scar endometriosis can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital, who were treated by surgery, between 2012 and 2017. The mean age was 32.71 ± 8.61 years (range: 19-45). Palpable mass and cyclic pain at the scar site were the most common complaints. Twelve patients had previously undergone CS, and two patients had undergone a surgery of ovarian endometrioma. The preoperative diagnosis was determined with ultrasonography (US), magnetic resonance imaging (MRI), or computed tomography (CT). Preoperatively, scar endometriosis was diagnosed in 12/14 patients (85.7%), while 2 patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical excision in all patients; in addition, mesh repair surgery was performed in 1 patient with recurrent scar endometriosis. Postoperatively, endometriosis was confirmed by histology in all patients. The average size of endometriomas was 24.71 ± 6.67 mm (range: 11-35). No woman had concurrent pelvic endometriosis. In the follow-up period (mean: 9 months) the recurrence of endometriosis was not observed. Scar endometriosis should be considered in all women of reproductive age presenting with cyclic pain and swelling in their abdominal incision sites.
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Affiliation(s)
- Faik Tatli
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Orhan Gozeneli
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Hacer Uyanikoglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Ali Uzunkoy
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Huseyin Cahit Yalcın
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Abdullah Ozgonul
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Osman Bardakci
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Adnan Incebiyik
- Department of Obstetrics and Gynecology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Muhammet Emin Guldur
- Department of Pathology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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824
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Singh A, Jaiswal SS. Incidentally Detected Carcinoma Gallbladder in Patients Undergoing Cholecystectomy. Indian J Surg 2018. [DOI: 10.1007/s12262-017-1614-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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825
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Seltene Ursache für rechtsseitigen Unterbauchschmerz. Chirurg 2018; 89:621-623. [DOI: 10.1007/s00104-018-0601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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826
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Zhu Y, Liu Z, Du M, Yi L, Gong G, Tang X. Macrophages in patients with recurrent endometrial polyps could exacerbate Th17 responses. Clin Exp Pharmacol Physiol 2018; 45:1128-1134. [PMID: 29908068 DOI: 10.1111/1440-1681.12994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/09/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022]
Abstract
Endometrial polyps (EPs) are outgrowths in the endometrium with unknown etiology. The fact that EPs can often recur after surgical removal suggests that EPs are not induced by random events but by continuous or recurrent processes in patients. We previously demonstrated that the risk of EP development was positively associated with overactive Th17 responses. However, the requirements of Th17 upregulation are yet unclear. Here, we recruited 26 women with symptomatic EP and 24 without EP, and peripheral mononuclear cells were harvested for the examination of circulating immunity. Compared to controls without EP, the patients with symptomatic EP presented significantly elevated levels of monocyte activation. The circulating monocytes from patients secreted higher levels of tumor necrosis factor (TNF), interleukin (IL)-1β, IL-6 and IL-23 directly ex vivo and with LPS stimulation. In memory CD4+ T cells, monocytes were not required for IL-17 expression, but the presence of activated monocytes significantly increased the secretion of IL-17. In naive CD4+ T cells, activated monocytes were required for significant IL-17 secretion and RORC transcription. Interestingly, the monocytes from EP individuals were significantly more potent in promoting Th17 differentiation from naive CD4+ T cells than the monocytes from controls. Furthermore, we showed that monocyte-mediated Th17 differentiation required the secretion of TNF, IL-1β and IL-6. Together, this study demonstrated activated monocytes supported Th17 inflammation in patients with EP.
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Affiliation(s)
- Yali Zhu
- Department of Gynaecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhihong Liu
- Department of Gynaecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Miaomiao Du
- Department of Gynaecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lisha Yi
- Department of Gynaecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guifang Gong
- Department of Gynaecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiang Tang
- Department of Gynaecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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827
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Shrestha B, Prasai PK, Kaskas AM, Khanna A, Letchuman V, Letchuman S, Alexander JS, Orr AW, Woolard MD, Pattillo CB. Differential arterial and venous endothelial redox responses to oxidative stress. Microcirculation 2018; 25:e12486. [PMID: 29923664 DOI: 10.1111/micc.12486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/15/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Oxidative stress is a central event linked with endothelial dysfunction and inflammation in several vascular pathologies, marked by over-production of ROS and concomitant decreases in antioxidants, for example GSH. Here, we distinguish endothelial oxidative stress regulation and associated functional disparities in the two main vascular conduits, (arteries and veins) following decreases in GSH. METHODS MAECs and VCECs were used as models of arterial and venular endothelium, respectively, and BSO (0-100 μmol/L) was used to indirectly increase cellular oxidative stress. Inflammatory responses were measured using immune cell attachment and immunoblotting for endothelial cell adhesion molecule (ICAM-1, VCAM-1) expression, altered cell proliferation, and wound healing. RESULTS MAECs and VCECs exhibited differential responses to oxidative stress produced by GSH depletion with VCECs exhibiting greater sensitivity to oxidative stress. Compared to MAECs, VCECs showed a significantly increased inflammatory profile and a decreased proliferative phenotype in response to decreases in GSH levels. CONCLUSIONS Arterial and venous endothelial cells exhibit differential responses to oxidant stress, and decreases in GSH:GSSG are more exacerbated in venous endothelial cells. Specific pathogenesis in these vascular conduits, with respect to oxidant stress handling, warrants further study, especially considering surgical interventions such as Coronary artery bypass grafting that use both interchangeably.
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Affiliation(s)
- Bandana Shrestha
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Priya K Prasai
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Amir M Kaskas
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Ankur Khanna
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Vijay Letchuman
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Sunjay Letchuman
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Jonathan Steven Alexander
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - A Wayne Orr
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana.,Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana.,Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Matthew D Woolard
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Christopher B Pattillo
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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828
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Kostina D, Zverev D, Grebennik V, Gordeev M, Ignatieva E, Voronkina I, Kostareva A, Malashicheva A. Aortic Graft at Coronary Artery Bypass Surgery as a Source of Human Aortic Smooth Muscle Cells. Cell Transplant 2018; 26:1663-1668. [PMID: 29251110 PMCID: PMC5753977 DOI: 10.1177/0963689717721226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
One of the serious obstacles of the aortopathies research is a considerable shortage of human aortic smooth muscle cells (SMCs), which can be used to model the disease. SMC in most cases come from the whole aorta of transplant donors, which are rather difficult to access. In the course of coronary artery bypass graft (CABG) surgery, a fragment of aortic tissue is excised to make a bypass root. In this study, we show a possibility to use CABG leftover fragments of thoracic aorta as a source of human SMC for in vitro research. We isolated SMC from the fragments of aortic tissues obtained during CABG procedure and compared these cells to the cells that were isolated from aortic tissue of transplant donors. The content of key SMC contractile markers (SMA, SM22α, and vimentin) as well as proliferation and migration rates, metalloproteases MMP-2 and MMP-9 activities were similar in CABG-derived SMC and in transplant donor–derived SMC. In conclusion, leftovers of ascending thoracic aorta obtained during CABG can be used as a source of human aortic SMCs for in vitro research.
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Affiliation(s)
- Daria Kostina
- 1 Almazov Federal Medical Research Centre, Saint Petersburg, Russia.,2 Peter the Great Saint Petersburg Polytechnic University, Saint Petersburg, Russia
| | - Dmitry Zverev
- 1 Almazov Federal Medical Research Centre, Saint Petersburg, Russia
| | - Vadim Grebennik
- 1 Almazov Federal Medical Research Centre, Saint Petersburg, Russia
| | - Mikhail Gordeev
- 1 Almazov Federal Medical Research Centre, Saint Petersburg, Russia
| | - Elena Ignatieva
- 1 Almazov Federal Medical Research Centre, Saint Petersburg, Russia
| | - Irina Voronkina
- 3 Institute of Cytology, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Anna Kostareva
- 1 Almazov Federal Medical Research Centre, Saint Petersburg, Russia
| | - Anna Malashicheva
- 1 Almazov Federal Medical Research Centre, Saint Petersburg, Russia.,4 Saint Petersburg State University, Saint Petersburg, Russia.,5 Institute of Translational Medicine, ITMO University, St. Petersburg, Russia
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829
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NSAID administration post colorectal surgery increases anastomotic leak rate: systematic review/meta-analysis. Surg Endosc 2018; 33:879-885. [DOI: 10.1007/s00464-018-6355-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
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830
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Wald DS, Wald BJ, Radford A, Shipolini A. The sternal wire code; Solving the problem of missing coronary artery bypass graft records during cardiac catheterization. IJC HEART & VASCULATURE 2018; 19:37-40. [PMID: 29946562 PMCID: PMC6016071 DOI: 10.1016/j.ijcha.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/17/2018] [Indexed: 11/25/2022]
Abstract
Background The sternal wire code records details of coronary artery bypass surgery (CABG) inside patients, based on the orientation of wires used for sternal closure. Visible on X-ray, the code overcomes the problem of missing graft-notes needed before repeat angiography. We determined (i) the potential value (ii) acceptability and (iii) accuracy of the code in practice. Methods (i) Consecutive coronary angiogram reports (2015–2016 Barts, London) were reviewed to identify patients with previous CABG and those with and without graft-notes before angiography. (ii) UK surgeons were surveyed on whether they would insert the code during CABG. (iii) A clinician, blinded to operative details, interpreted 16 post-CABG X-rays, 8 with the code and 8 without. Results (i) Of 6483 angiography patients, 559 had previous CABG (9.2% (8.5–10%)). Graft-notes were missing in 91/559 (15.1% (12–18%)); almost all (88/91) among patients with acute myocardial infarction. (ii) In the survey, 66/71surgeons (93% (84–98%)) were willing to use the code. (iii) In the accuracy test, all coded X-rays were identified and 28/28 grafts correctly interpreted (p < 0.001). Conclusions About 1 in 6 patients with previous CABG, who require emergency coronary angiography, undergo this procedure without graft-notes and would benefit from the sternal wire code which appears clinically acceptable and accurate.
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Affiliation(s)
- David S Wald
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Ben J Wald
- Dulwich College, Dulwich Common, London SE21 7LD, United Kingdom
| | - Angus Radford
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Alex Shipolini
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
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831
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Ekici U, Yılmaz S, Tatlı F. Comparative Analysis of Laparoscopic Cholecystectomy Performed in the Elderly and Younger Patients: Should We Abstain from Laparoscopic Cholecystectomy in the Elderly? Cureus 2018; 10:e2888. [PMID: 30159214 PMCID: PMC6110625 DOI: 10.7759/cureus.2888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The elderly population is gradually increasing due to an increase in the quality of life and therefore the frequency of gallbladder stones in the population is also increasing. However, a considerable number of physicians tend to postpone or solve the problem with medical treatment instead of performing surgery in the elderly patients. In this study, we aim to compare the outcomes of laparoscopic cholecystectomy (LC) in the elderly and younger patients. MATERIAL AND METHODS The medical records of 665 patients undergoing LC were evaluated retrospectively. The patients were divided into two groups: ≥60 years of age and <60 years of age. Ages, genders, comorbid diseases, indications of surgery, American Society of Anesthesiologists scores, whether it is converted to an open cholecystectomy or not, reasons for conversion if it is converted, total duration of surgery, initiation of oral nutrition, duration of discharge, and postoperative complications of the patients in both groups were recorded. RESULTS The American Society of Anesthesiologists scores were statistically significantly higher in ≥60 years age group (p<0.001). The rate of experiencing acute cholecystitis with a stone in the gallbladder was significantly higher in the 60 years group (p=0.025). Comorbidity was statistically significantly higher in the ≥60 years age group (p<0.001). Hospitalization period, the mean hour of initiation of oral nutrition were statistically significantly higher in the ≥60 years age group (p<0.001, p=0.001). Conversion to an open cholecystectomy and postoperative complication rates of the ≥60 years age group were statistically significantly higher (p=0.034, p<0.001). CONCLUSION We think that LC can be safely performed in the elderly people as well. However, it should be kept in mind that comorbidity may make the surgery and postoperative follow-up period complicated.
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Affiliation(s)
- Ugur Ekici
- Health Science and Administratioon, İstanbul Gelisim University, İstanbul, TUR
| | - Serhan Yılmaz
- General Surgery, Bakirkoy Sadi Konuk Education and Research Hospital, İstanbul, TUR
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832
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Zhu J, Liu J, Shen G, Zhong T, Yu X. Comparison of Efficacy Outcomes of Lidocaine Spray, Topical Lidocaine Injection, and Lidocaine General Anesthesia in Nasal Bone Fractures Surgeries: A Randomized, Controlled Trial. Med Sci Monit 2018; 24:4386-4394. [PMID: 29941861 PMCID: PMC6050998 DOI: 10.12659/msm.908468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Lidocaine is widely used as a general and local anesthetic in minor or major surgeries. The objective of the study was to compare postoperative pain relief and adverse events using different forms of lidocaine administration in patients following closed nasal bone reduction surgery. Material/Methods A total of 381 patients with a solitary nasal fracture that could be managed with closed reduction were included in this study and divided into 3 groups of 127 patients in each group. Patients had received 1% lidocaine HCl with epinephrine (LL group), inserted a mesh impregnated with lidocaine spray (TL group), or 1 mg/kg/h lidocaine infusion (GL group) before surgeries. Patients also received morphine when the pain was not controlled. The postoperative pain was assessed at 6 hours and 48 hours after surgery. Postoperative vomiting and nausea were evaluated. Repeated ANOVA/Tukey-Kramer multiple comparisons test was performed at 95% confidence level. Results At 6 hours after surgery, patients in the general lidocaine (GL) group reported decreased postoperative pain compared with those in the topical lidocaine (TL) group (P<0.001, q=6.633) and LL group (P<0.001, q=8.056). The morphine consumption within 48 hours was least in GL group than TL group (P<0.001, q=172.9) and LL group (P<0.001, q=226.42). Lidocaine infusion caused nausea (P<0.001, q=6.742) and vomiting (P<0.001, q=4.306). Conclusions Topical lidocaine anesthesia had the same postoperative pain relief and the least adverse events as local and general lidocaine anesthesia.
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Affiliation(s)
- Jihong Zhu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jian Liu
- Department of General Surgery, Wuyi Traditional Chinese Medical Hospital, Jinhua, Zhejiang, China (mainland)
| | - Guoying Shen
- Our-Patient Department, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Taidi Zhong
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xin Yu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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833
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Desta M, Ayenew T, Sitotaw N, Tegegne N, Dires M, Getie M. Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos referral hospital, Northwest Ethiopia. BMC Health Serv Res 2018; 18:465. [PMID: 29914477 PMCID: PMC6006704 DOI: 10.1186/s12913-018-3277-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare-associated infections are a major global public health agenda. Health care workers are front line of protecting themselves and clients from infection. This study examined the knowledge and practice of healthcare workers on infection prevention and its associated factors among health professionals working at Debre Markos Referral Hospital. METHODS A Hospital-based cross-sectional study was conducted with a structured pre-tested questionnaire among 150 participants. The healthcare workers were selected through systematic random sampling technique. Multivariate logistic regressions were computed to identify associated factors of knowledge and practice of infection prevention and variables with a p-value < 0.05 were considered statistically significant. RESULTS More than two thirds (84.7%) of healthcare workers were found to be knowledgeable but only 86 (57.3%) of respondents demonstrated a good practice on infection prevention. Older age, lengthy work experience and higher educational status were significantly associated with both knowledge and practice of infection prevention. In-service training, availability of infection prevention supplies and adherence to infection prevention guidelines was also associated with the practice of infection prevention. CONCLUSIONS The finding of this study revealed a good knowledge of infection prevention on the majority of participants with relatively minimal practice rate. Sociodemographic factors and health facility factors were associated with knowledge and practice of infection prevention. Hospitals and other concerned stakeholders should ensure constant availability of guidelines and the provision of training to health providers. Moreover, developing professionals' educational level, introducing infection prevention standard of practice and continuous mentorship was recommended.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, PO. Box: 269, Debre Markos, Ethiopia
| | - Temesgen Ayenew
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Nega Sitotaw
- Nursing health professional, Felegehiwot referral Hospital, Bahirdar, Amhara region Ethiopia
| | - Nibretie Tegegne
- Nursing health professional, Dejen Health center, Dejen, Amhara region Ethiopia
| | - Muluken Dires
- Nursing health professional, Felegehiwot referral Hospital, Bahirdar, Amhara region Ethiopia
| | - Mulualem Getie
- Nursing health professional, Medawalebu university teaching hospital, Medawalebu, Oromia region Ethiopia
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834
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Noorit P, Siribumrungwong B, Thakkinstian A. Clinical prediction score for superficial surgical site infection after appendectomy in adults with complicated appendicitis. World J Emerg Surg 2018; 13:23. [PMID: 29946346 PMCID: PMC6006790 DOI: 10.1186/s13017-018-0186-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/05/2018] [Indexed: 01/26/2023] Open
Abstract
Background Superficial surgical site infection (SSI) is common after appendectomy. This study aims to determine a clinical prediction score for SSI after appendectomy in complicated appendicitis. Methods Data from randomized controlled trial of delayed versus primary wound closures in complicated appendicitis was used. Nineteen patient- and operative-related predictors were selected in the logit model. Clinical prediction score was then constructed using coefficients of significant predictors. Risk stratification was done by receiver operating characteristic (ROC) curve analysis. Bootstrap technique was used to internal validate the score. Results Among 607 patients, the SSI incidence was 8.7% (95% CI 6.4, 11.2). Four predictors were significantly associated with SSI, i.e., presence of diabetes, incisional length > 7 cm, fecal contamination, and operative time > 75 min with the odds ratio of 2.6 (95% CI 1.2, 5.9), 2.8 (1.5, 5.4), 3.6 (1.9, 6.8), and 3.4 (1.8, 6.5), respectively. Clinical prediction score ranged from 0 to 4.5 with its discrimination concordance (C) statistic of 0.74 (95% CI 0.66, 0.81). Risk stratification classified patients into very low, low, moderate, and high risk groups for SSI when none, one, two, and more than two risk factors were presented with positive likelihood ratio of 1.00, 1.45, 3.32, and 9.28, respectively. A bootstrap demonstrated well calibration and thus good internal validation. Conclusions Diabetes, incisional length, fecal contamination, and operative time could be used to predict SSI with acceptable discrimination. This clinical risk prediction should be useful in prediction of SSI. However, external validation should be performed. Trial registration ClinicalTrials.gov (ID NCT01659983), registered August 8, 2012 Electronic supplementary material The online version of this article (10.1186/s13017-018-0186-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pinit Noorit
- 1Department of Surgery, Chonburi hospital, Chonburi, Thailand
| | - Boonying Siribumrungwong
- 2Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Pathum thani, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI road, Rachatevi, Bangkok, 10400 Thailand
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835
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Diaz Quiroz JF, Rodriguez PD, Erndt-Marino JD, Guiza V, Balouch B, Graf T, Reichert WM, Russell B, Höök M, Hahn MS. Collagen-Mimetic Proteins with Tunable Integrin Binding Sites for Vascular Graft Coatings. ACS Biomater Sci Eng 2018; 4:2934-2942. [DOI: 10.1021/acsbiomaterials.8b00070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Juan Felipe Diaz Quiroz
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180, United States
| | - Patricia Diaz Rodriguez
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180, United States
| | - Josh D. Erndt-Marino
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180, United States
| | - Viviana Guiza
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180, United States
| | - Bailey Balouch
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180, United States
| | - Tyler Graf
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180, United States
| | - William M. Reichert
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Brooke Russell
- Institute of Biosciences and Technology, Texas A&M Health Science Center, College Station, Texas 77843, United States
| | - Magnus Höök
- Institute of Biosciences and Technology, Texas A&M Health Science Center, College Station, Texas 77843, United States
| | - Mariah S. Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180, United States
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836
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Jarmolowicz DP, Hudnall JL, Hale L, Fowler SC, Bortolato M, Lemley SM, Sofis MJ. Delay discounting as impaired valuation: Delayed rewards in an animal obesity model. J Exp Anal Behav 2018; 108:171-183. [PMID: 28940395 DOI: 10.1002/jeab.275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/26/2017] [Indexed: 12/21/2022]
Abstract
Obesity is a major public health problem, which, like many forms of addiction, is associated with an elevated tendency to choose smaller immediate rather than larger delayed rewards, a response pattern often referred to as excessive delay discounting. Although some accounts of delay discounting conceptualize this process as impulsivity (placing the emphasis on overvaluing the smaller immediate reward), others have conceptualized delay discounting as an executive function (placing the emphasis on delayed rewards failing to retain their value). The present experiments used a popular animal model of obesity that has been shown to discount delayed rewards at elevated rates (i.e., obese Zucker rats) to test two predictions that conceptualize delay discounting as executive function. In the first experiment, acquisition of lever pressing with delayed rewards was compared in obese versus lean Zucker rats. Contrary to predictions based on delay discounting as executive function, obese Zucker rats learned to press the lever more quickly than controls. In the second experiment, progressive ratio breakpoints (a measure of reward efficacy) with delayed rewards were compared in obese versus lean Zucker rats. Contrary to the notion that obese rats fail to value delayed rewards, the obese Zucker rats' breakpoints were (at least) as high as those of the lean Zucker rats.
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837
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Farndon L, Stephenson J, Binns-Hall O, Knight K, Fowler-Davis S. The PodPAD project: a podiatry-led integrated pathway for people with peripheral arterial disease in the UK - a pilot study. J Foot Ankle Res 2018; 11:26. [PMID: 29991966 PMCID: PMC5987540 DOI: 10.1186/s13047-018-0269-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral arterial disease affects the lower limb and is associated with diabetes, high cholesterol, smoking and obesity. It increases the risk of cardiovascular morbidity and mortality. It can be symptomatic causing intermittent claudication, but often there are few clinical signs. Podiatrists are able to detect the presence of peripheral arterial disease as part of their lower limb assessment and are well placed to give advice on lifestyle changes to help reduce disease progression. This is important to improve health outcomes and is offered as a prevention/public health intervention. Method We describe the clinical and patient-centred outcomes of patients attending a podiatry-led integrated care pathway in a multi-use clinic situated in a venue supported by the National Centre for Sports and Exercise Medicine in the UK. At the baseline appointment, patients were given a full assessment where symptoms of intermittent claudication using the Edinburgh Intermittent Claudication Questionnaire, foot pulses, Doppler sounds, Ankle Brachial Pressure Indices, glycated haemoglobin (HbA1c) and cholesterol levels, and smoking status were recorded. A tailored treatment plan was devised, including referral to an exercise referral service, smoking cessation programmes (if applicable) and each participant was also seen by a dietician for nutritional advice. Participants were followed up at 3 and 6 months to assess any improvement in vascular status and with each completing the EQ-5D quality of life questionnaire and a simple satisfaction questionnaire at the end of the study. As this was a complex intervention a pilot study design was adopted to evaluate if the method and outcomes were suitable and acceptable to participants the results of which will then inform the design of a larger study. Results Data was collected on 21 individuals; 15 men (71.4%) and 6 women (28.6%) across the 6-month study period. Eleven participants were referred onto the exercise referral service; 16 participants saw the dietician for nutritional advice at baseline and had one-to-one or telephone follow-up at 3 months. Five out of 14 participants had reduced scores from baseline of intermittent claudication during the study period. No evidence for substantive changes in Doppler sounds or ABPI measurements was revealed. Quality of life scores with the EQ-5D improved in 15 participants; this was statistically significant (p = 0.007) with 14 participants who completed the simple satisfaction questionnaire expressing a positive view of the programme. Of the four people who were smokers, two stopped smoking cigarettes and moved to e-cigarettes as part of smoking cessation advice. Conclusion As this was a pilot study the sample size was low, but some statistically significant improvements with some measures were observed over the 6-month study. Podiatrists are able to provide a comprehensive vascular assessment of the lower limb and accompanying tailored advice on lifestyle changes including smoking cessation and exercise. Locating clinics in National Centres for Sports and Exercise Medicine enables easy access to exercise facilities to encourage the adoption of increased activity levels, though the long term sustainability of exercise programmes still requires evaluation.This study was reviewed and approved by London Brent Ethics Committee IRAS ID 204611 and received research governance approval from the sponsor, Sheffield Teaching Hospitals NHS Foundation Trust Research and Innovation Office STH19410.
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Affiliation(s)
- Lisa Farndon
- 1Sheffield Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Stephenson
- 2School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Oliver Binns-Hall
- 1Sheffield Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kayleigh Knight
- 1Sheffield Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sally Fowler-Davis
- 3Sheffield Hallam University /Combined Community & Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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838
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Implementing Enhanced Recovery After Surgery (ERAS) Program on a Specialty Nursing Unit. ACTA ACUST UNITED AC 2018; 48:303-309. [DOI: 10.1097/nna.0000000000000619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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839
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Shaban Y, Elkbuli A, McKenney M, Boneva D. Amyand's hernia: A case report and review of the literature. Int J Surg Case Rep 2018; 47:92-96. [PMID: 29753277 PMCID: PMC5994736 DOI: 10.1016/j.ijscr.2018.04.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/29/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION An Amyand hernia is a rare disease where the appendix is found within an inguinal hernia sac. This rare entity is named after the French born English surgeon, Dr. Claudius Amyand. Inguinal hernias are one of the most common surgeries that a general surgeon performs with more than 20 million inguinal hernia repairs performed yearly worldwide. The incidence of finding an appendix within the hernia sac is rare, occurring in less than 1% of inguinal hernia patients and when complications arise such as inflammation, perforation, or abscess formation it becomes exceptionally rare with an incidence of about 0.1%. PRESENTATION OF CASE A 59-year-old male with a history of a previously reducible right inguinal hernia presented to the Emergency Department with acute abdominal pain, right groin mass. Computed tomography (CT) confirmed a right incarcerated inguinal hernia with herniated loops of bowel within the right inguinal region. Patient was subsequently treated with an appendectomy and tension free hernia repair with mesh with a successful outcome. DISCUSSION The current generally accepted treatment algorithm for Amyand's hernia is essentially contingent on the appendix's condition within the hernia sac. Controversy exists regarding the application of mesh in type 2 Amyand's hernia. More research is needed to provide surgeons with evidence-based standardized approaches for dealing with this unique situation. CONCLUSION This case report reviews a rare entity known as an Amyand's hernia that presented as an incarcerated hernia that was diagnosed intraoperatively with an inflamed appendix, recognized as a type 2 Amyand's hernia.
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Affiliation(s)
- Youssef Shaban
- Department of Surgery, Kendall Regional Medical Center, 11750 Bird Road, Miami, FL, 33175, United States
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, 11750 Bird Road, Miami, FL, 33175, United States.
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, 11750 Bird Road, Miami, FL, 33175, United States
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, 11750 Bird Road, Miami, FL, 33175, United States
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840
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Koppatz H, Nordin A, Scheinin T, Sallinen V. The risk of incidental gallbladder cancer is negligible in macroscopically normal cholecystectomy specimens. HPB (Oxford) 2018; 20:456-461. [PMID: 29248400 DOI: 10.1016/j.hpb.2017.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/11/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cholecystectomy is usually carried out for benign indications. Most perform routine histopathologic examination to detect incidental gallbladder cancer (GBC). METHODS Cholecystectomies performed at four hospitals in the Helsinki Metropolitan Area during 2010-2012 were analyzed retrospectively. Patients with preoperative suspicion of neoplasia, active malignancy, or in whom cholecystectomy was performed as a secondary procedure were excluded. RESULTS A total of 2034 cholecystectomies were included. In ten patients (0.5%), GBC was identified, each with an associated macroscopic finding, including local hardness (n = 1), a thickened wall (n = 5), acute inflammation and necrosis (n = 1), or suspected neoplasia (n = 3). No GBC was found in macroscopically normal gallbladders (n = 1464). Of the ten patients with GBC, five underwent subsequent liver resection, four had metastatic disease, and one had locally advanced inoperable disease. Three of the five patients who underwent liver resection were alive and disease-free at final follow-up (median 48 months). The remaining seven patients with GBC died of the disease, with a median survival of 14 months (range 10-48 months). CONCLUSIONS Routine histopathologic examination of a macroscopically normal gallbladder does not improve diagnosis of GBC. A histopathological examination is, however, mandatory when a macroscopic abnormality is present.
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Affiliation(s)
- Hanna Koppatz
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tom Scheinin
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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841
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842
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Rossell J, González M, Mestres N, Pardina E, Ricart-Jané D, Peinado-Onsurbe J, Baena-Fustegueras JA. Diet Change After Sleeve Gastrectomy Is More Effective for Weight Loss Than Surgery Only. Obes Surg 2018; 27:2566-2574. [PMID: 28342156 DOI: 10.1007/s11695-017-2650-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bariatric surgery with or without diet change has become one of the most effective treatments for obesity. The objective of this study was to observe the effects of vertical sleeve gastrectomy (VSG) and diet change in Sprague-Dawley rats on both body and tissue weights. METHODS Eighteen rats were fed with a standard chow diet (SCD) (C group), and 36 rats were fed with a high-fat diet (HFD) (diet-induced obesity (DIO) group). After 8 weeks, the animals underwent VSG, sham surgery or no surgery (NS). After surgery, a third of the rats fed with the HFD changed to the SCD (DIO + C group). Body weight, food and energy intake were recorded daily during the experiment (12 weeks). Food efficiency (%) (FE) was determined from weekly weight gain and weekly kilocalorie consumed measurements. RESULTS The DIO group had higher and significant weight gain than the C group at the time of surgery (p < 0.001). The major weight loss (WL) was observed in the DIO + C-VSG group, during the 4 weeks after surgery. Adipose tissues in the DIO + C-VSG group were drastically reduced and had a weight similar to those in the C-VSG group. CONCLUSION VSG and the diet change combination led to a greater WL, which was maintained during the 4 weeks post-surgery, leading to a normalization of body weight. VSG and diet change also affected most of the tissues, not only adipose, showing a global change in whole body composition.
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Affiliation(s)
- Joana Rossell
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Diagonal 643, 08028, Barcelona, Spain
| | - Marta González
- Unitat de Cirurgia, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida, Spain
| | - Núria Mestres
- Unitat de Cirurgia, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida, Spain
| | - Eva Pardina
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Diagonal 643, 08028, Barcelona, Spain
| | - David Ricart-Jané
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Diagonal 643, 08028, Barcelona, Spain
| | - Julia Peinado-Onsurbe
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Diagonal 643, 08028, Barcelona, Spain.
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843
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Corcione A, Angelini P, Bencini L, Bertellini E, Borghi F, Buccelli C, Coletta G, Esposito C, Graziano V, Guarracino F, Marchi D, Misitano P, Mori AM, Paternoster M, Pennestrì V, Perrone V, Pugliese L, Romagnoli S, Scudeller L, Corcione F. Joint consensus on abdominal robotic surgery and anesthesia from a task force of the SIAARTI and SIC. Minerva Anestesiol 2018; 84:1189-1208. [PMID: 29648413 DOI: 10.23736/s0375-9393.18.12241-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minimally invasive surgical procedures have revolutionized the world of surgery in the past decades. While laparoscopy, the first minimally invasive surgical technique to be developed, is widely used and has been addressed by several guidelines and recommendations, the implementation of robotic-assisted surgery is still hindered by the lack of consensus documents that support healthcare professionals in the management of this novel surgical procedure. Here we summarize the available evidence and provide expert opinion aimed at improving the implementation and resolution of issues derived from robotic abdominal surgery procedures. A joint task force of Italian surgeons, anesthesiologists and clinical epidemiologists reviewed the available evidence on robotic abdominal surgery. Recommendations were graded according to the strength of evidence. Statements and recommendations are provided for general issues regarding robotic abdominal surgery, operating theatre organization, preoperative patient assessment and preparation, intraoperative management, and postoperative procedures and discharge. The consensus document provides evidence-based recommendations and expert statements aimed at improving the implementation and management of robotic abdominal surgery.
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Affiliation(s)
- Antonio Corcione
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Pierluigi Angelini
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Lapo Bencini
- Division of Surgical Oncology and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Elisabetta Bertellini
- Department of Anesthesia and Intensive Care, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Felice Borghi
- Division of General and Surgical Oncology, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Coletta
- Division of Operating Room Management, Department of Emergency and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Clelia Esposito
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Vincenzo Graziano
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Domenico Marchi
- Department of General Surgery, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Pasquale Misitano
- Unit of General and Mini-Invasive Surgery, Department of General Surgery, Misericordia Hospital, Grosseto, Italy
| | - Anna M Mori
- Department of Anesthesiology and Reanimation, IRCCS Policlinic San Matteo Foundation, Pavia, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Pennestrì
- Department of Anesthesia and Intensive Care Medicine, Misericordia Hospital, Grosseto, Italy
| | - Vittorio Perrone
- Department of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Luigi Pugliese
- Unit of General Surgery 2, IRCCS Policlinic San Matteo, Foundation, Pavia, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy -
| | - Francesco Corcione
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
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844
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Masci E, Faillace G, Longoni M. Use of oxidized regenerated cellulose to achieve hemostasis during laparoscopic cholecystectomy: a retrospective cohort analysis. BMC Res Notes 2018; 11:239. [PMID: 29642951 PMCID: PMC5896066 DOI: 10.1186/s13104-018-3344-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/30/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Laparoscopic cholecystectomy is the first-choice treatment for symptomatic cholelithiasis. Though generally safe, this procedure is not without complications, with bleeding the most frequent cause of conversion to open cholecystectomy. Oxidized regenerated cellulose (ORC) added to conventional hemostatic strategies, is widely used to control bleeding during surgery despite limited evidence supporting its use. This retrospective study analyzed patients undergoing laparoscopic cholecystectomy in an Italian center over a 16-month period, between October 2014 and February 2016, who experienced uncontrollable bleeding despite the use of conventional hemostatic strategies, requiring the addition of ORC gauze (Emosist®). RESULTS Of the 530 patients who underwent laparoscopic cholecystectomy, 24 (4.5%) had uncontrollable bleeding from the liver bed. Of these, 62.5% had acute cholecystitis and 33.3% chronic cholecystitis; 1 patient was diagnosed with gallbladder carcinoma, postoperatively. Most patients had comorbidities, 16.7% had liver cirrhosis, and 37.5% used oral anticoagulants. The application of ORC rapidly controlled bleeding in all patients. Patients were discharged after a mean duration of 2.2 days. ORC was easy to use and well tolerated. Bleeding complications remain a relevant issue in laparoscopic cholecystectomy. ORC was able to promptly stop bleeding not adequately controlled by conventional methods and appears, therefore, to be a useful hemostat.
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Affiliation(s)
- Emilia Masci
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
| | - Giuseppe Faillace
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
| | - Mauro Longoni
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
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845
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Mandengue CE, Denning DW. The Burden of Serious Fungal Infections in Cameroon. J Fungi (Basel) 2018; 4:E44. [PMID: 29601494 PMCID: PMC6023387 DOI: 10.3390/jof4020044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 12/24/2022] Open
Abstract
Fungal infections are frequent in Cameroon, and invasive fungal infections are sometimes detected, usually in HIV-infected patients. For these reasons, we have estimated the burden of fungal infections. Using published literature and population estimates for the at-risk group, we used deterministic modelling to derive national incidence and prevalence estimates for the most serious fungal diseases. HIV infection is common and an estimated 120,000 have CD4 counts <200 × 10⁶/mL and commonly present with opportunistic infection. Oesophageal candidiasis in HIV is common, and in poorly controlled diabetics. We estimate 6720 cases of cryptococcal meningitis, 9000 of Pneumocystis pneumonia, 1800 of disseminated histoplasmosis annually complicating AIDS, and 1200 deaths from invasive aspergillosis in AIDS, but there are no data. We found that 2.4% of adults have chronic obstructive pulmonary disease (COPD) and 2.65% have asthma, with "fungal asthma" affecting 20,000. Chronic pulmonary aspergillosis probably affects about 5000 people, predominantly after tuberculosis but also with COPD and other lung diseases. Also, tinea capitis in schoolchildren is frequent. Overall, an estimated 1,235,775 people are affected by a serious fungal infection. There is an urgent need for government and clinician attention, improved laboratory facilities, fungal diagnostic tests, and competent laboratory technicians, as well as all World Health Organization (WHO)-endorsed essential antifungal drugs to be made available, as only fluconazole is registered and available in the country.
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Affiliation(s)
- Christine E Mandengue
- Department of Internal Medicine (Dermatology), Université des Montagnes, Bangangté P.O. Box 208, Cameroon (Central Africa).
| | - David W Denning
- National Aspergillosis Centre, Wythenshawe Hospital and The University of Manchester, Manchester M13 9PL, UK.
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846
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Percalli L, Pricolo R, Passalia L, Riccò M. Comparison between self-gripping, semi re-absorbable meshes with polyethylene meshes in Lichtenstein, tension-free hernia repair: preliminary results from a single center. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:72-78. [PMID: 29633746 PMCID: PMC6357604 DOI: 10.23750/abm.v89i1.6594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/31/2017] [Indexed: 01/06/2023]
Abstract
Even tough inguinal hernia repair is among the commonest operations in general surgery, the choice for an optimal approach continues to be a controversial topic. Because of the low recurrence rates and low prevalence of complications, tension-free mesh augmented operation has become the standard technique in inguinal hernia surgery, significantly reducing hernia recurrence rates. On the contrary, prevalence of chronic postoperative groin pain (CPGI) i.e. pain beyond a three month-postoperative period still remains significant: as rates of CPGI may range between 15% and 53%, surgical approaches aimed to avoid chronic post-hernioplasty pain have been extensively debated, and the avoidance of CPGI has become one of the primary endpoints of surgical research on inguinal hernia repair). Recently, a sound base of evidence suggested that the entrapment of peripheral nervous fibers innervating part of the structures in the inguinal canal and stemming from ilioinguinal (Th12), iliohypogastric (L1) nerves as well as from the genital branch of the genito-femoral nerve (L1, L2), may eventually elicit CPGI (1-10). Consequently, innovative fixation modalities (e.g. self-gripping meshes, glue fixation, absorbable sutures), and new material types (e.g. large-pored meshes) with self-adhesive sticking or mechanical characteristics, have been developed in order to avoid penetrating fixings such as sutures, clips and tacks. However, some uncertainties still remain about the pros and cons of such meshes in terms of chronic pain, as new, innovative mesh apparently does not significantly reduce the rate of CPGI. Parietex ProGrip® (MedtronicsTM) is a bicomponent mesh comprising of monofilament polyester and a semi re-absorbable polylactic acid gripping system that allows sutureless fixation of prosthetic mesh to the posterior inguinal wall. As ProGrip® does not requires additional fixation, inguinal canal may be closed within minutes after adequate groin dissection, ultimately shortening operating time. In other words, ProGrip® has the potential for significant savings, in terms of surgical and post-operating costs as well (10). The aim of our study is therefore to compare the results of the same technique with two different mesh materials (ProGrip® mesh vs. polyethylene mesh), in terms of operative time, post-operative pain, complications, and recurrence rates. (www.actabiomedica.it)
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Affiliation(s)
- Luigi Percalli
- UO General Surgery - Departement of Surgery AUSL Piacenza.
| | - Renato Pricolo
- UO Surgery - Surgical Departement of ASSP Lodi - Codogno Hospital via G. Marconi 1, 26845 Codogno (LO).
| | | | - Matteo Riccò
- Local Health Unit of Reggio Emilia - Department of Public Health - Occupational Health and Safety Unit. V.le Amendola n.2 - 42022 Reggio Emilia (RE).
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847
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Jones B, Berent AC, Weisse CW, Hart R, Alvarez L, Fischetti A, Horn BD, Canning D. Surgical and endoscopic treatment of bladder exstrophy-epispadias complex in a female dog. J Am Vet Med Assoc 2018; 252:732-743. [PMID: 29504860 DOI: 10.2460/javma.252.6.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 14-week-old 7.7-kg (16.9-lb) sexually intact female Golden Retriever was evaluated because of urine dripping from the caudoventral aspect of the abdomen. CLINICAL FINDINGS Ultrasonography, radiography, excretory CT urography, and vaginocystourethroscopy were performed. Results indicated eversion of the bladder through the ventral abdominal wall with exposure of the ureterovesicular junctions, pubic diastasis, and an open vulva and clitoral fossa. Clinical findings were suggestive of bladder exstrophy, a rare congenital anomaly. TREATMENT AND OUTCOME The dog was anesthetized and bilateral ileal osteotomies were performed. Two ureteral catheters were passed retrograde into the renal pelves under fluoroscopic guidance. The lateral margins of the bladder, bladder neck, and urethra were surgically separated from the abdominal wall, and the bladder was closed, forming a hollow viscus. The symphysis pubis was closed on midline with horizontal mattress sutures. The defects in the vestibule and clitoral fossa were closed. Lastly, the iliac osteotomies were stabilized. The dog was initially incontinent with right hind limb sciatic neuropraxia and developed pyelonephritis. Over time, the dog became continent with full return to orthopedic and neurologic function, but had recurrent urinary tract infections, developed renal azotemia likely associated with chronic pyelonephritis, and ultimately was euthanized 3.5 years after surgery because of end-stage kidney disease. CLINICAL RELEVANCE Bladder exstrophy and epispadias is a treatable but rare congenital abnormality. The procedure described could be considered for treatment of this condition, but care should be taken to monitor for urinary tract infections and ascending pyelonephritis.
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848
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Chan DJ, Furner V, Smith DE, Dronavalli M, Bopage RI, Post JJ, Bhardwaj AK. Non-AIDS complexity amongst patients living with HIV in Sydney: risk factors and health outcomes. AIDS Res Ther 2018; 15:6. [PMID: 29519243 PMCID: PMC5844086 DOI: 10.1186/s12981-018-0193-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/02/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the prevalence of non-AIDS co-morbidities (NACs) and predictors of adverse health outcomes amongst people living with HIV in order to identify health needs and potential gaps in patient management. DESIGN Retrospective, non-consecutive medical record audit of patients attending a publicly funded HIV clinic in metropolitan Sydney analysed for predictors of adverse health outcomes. We developed a scoring system based on the validated Charlson score method for NACs, mental health and social issues and confounders were selected using directed acyclic graph theory under the principles of causal inference. RESULTS 211 patient files were audited non-consecutively over 6 weeks. 89.5% were male; 41.8% culturally and linguistically diverse and 4.1% were of Aboriginal/Torres Strait Islander origin. Half of patients had no general practitioner and 25% were ineligible for Medicare subsidised care. The most common NACs were: cardiovascular disease (25%), hepatic disease (21%), and endocrinopathies (20%). One-third of patients had clinical anxiety, one-third major depression and almost half of patients had a lifetime history of tobacco smoking. Five predictors of poor health outcomes were identified: (1) co-morbidity score was associated with hospitalisation (odds ratio, OR 1.58; 95% CI 1.01-2.46; p = 0.044); (2) mental health score was associated with hospitalisation (OR 1.79; 95% CI 1.22-2.62; p = 0.003) and poor adherence to ART (OR 2.34; 95% CI 1.52-3.59; p = 0.001); (3) social issues score was associated with genotypic resistance (OR 2.61; 95% CI 1.48-4.59; p = 0.001), co-morbidity score (OR 1.69; 95% CI 1.24-2.3; p = 0.001) and hospitalisation (OR 1.72; 95% CI 1.1-2.7; p = 0.018); (4) body mass index < 20 was associated with genotypic resistance (OR 6.25; 95% CI 1.49-26.24; p = 0.012); and (5) Medicare eligibility was associated with co-morbidity score (OR 2.21; 95% CI 1.24-3.95; p = 0.007). CONCLUSION Most HIV patients are healthy due to effective antiretroviral therapy; however, NACs and social/mental health issues are adding to patient complexity. The current findings underpin the need for multidisciplinary management beyond routine viral load and CD4 count monitoring.
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Affiliation(s)
- Derek J. Chan
- Albion Centre, South Eastern Sydney Local Health District, Sydney, NSW 2010 Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Virginia Furner
- Albion Centre, South Eastern Sydney Local Health District, Sydney, NSW 2010 Australia
| | - Don E. Smith
- Albion Centre, South Eastern Sydney Local Health District, Sydney, NSW 2010 Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Mithilesh Dronavalli
- Albion Centre, South Eastern Sydney Local Health District, Sydney, NSW 2010 Australia
| | - Rohan I. Bopage
- Albion Centre, South Eastern Sydney Local Health District, Sydney, NSW 2010 Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Jeffrey J. Post
- Albion Centre, South Eastern Sydney Local Health District, Sydney, NSW 2010 Australia
- Department of Infectious Diseases, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, NSW 2010 Australia
- Prince of Wales Clinical School, UNSW, Sydney, NSW 2051 Australia
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849
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Aleksandar K, Miodagl D, Nebojsa D, Ilija G. Effect of fibrin vs cellulose based haemostatic agents with traditional haemostatic procedures in thyroid surgery. Pak J Med Sci 2018; 33:1360-1365. [PMID: 29492059 PMCID: PMC5768825 DOI: 10.12669/pjms.336.13692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To compare the efficacy of fibrin-based hemostat and cellulose-based hemostat with traditional procedures in patients undergoing thyroid surgery. Methods: Between January 2012 and December 2016, 255 patients were scheduled to undergo total thyroidectomy at Surgical Clinic Nis. The patients were randomized to: Group-I use of classic surgical procedures to achieve hemostasis, Group-II use Surgicel and Group-III use Beriplas Results: A statistically significant reduction of surgical time was found for Group-I compared with Group-II and III (p≤0.01 for both groups). Statistically significant reduction of intraoperative blood loss was found for Group-I compared with Group-II from 102.3mL vs. 86.1mL (p≤0.01) as well as compared to Group-III (mean 77.4mL, p≤0.01). Removal of the wound drain occurred sooner in the Group-II and III compared with Group-I (mean 37.1h vs. 40.1h, p≤0.05; mean 31.2h vs. 40.1h, p≤0.01). There were no significant differences in terms of postoperative morbidity among the groups. Conclusions: Fibrin based haemostat seems to be an effective hemostatic agent for patients undergoing thyroid surgery. We suggest that, where appropriate, this fibrin-based haemostat should be used as a first line hemostatic agent in thyroidectomy in combination with conventional surgical means of hemostasis.
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Affiliation(s)
- Karanikolic Aleksandar
- Dr. Karanikolic Aleksandar, MD, PhD. Medical Faculty Nis, University of Nis, Serbia. Surgical Clinic, Clinical center Nis, Serbia
| | - Djordjevic Miodagl
- Dr. Djordjevic Miodag, MD. Medical Faculty Nis, University of Nis, Serbia. Surgical Clinic, Clinical center Nis, Serbia
| | - Djordjevic Nebojsa
- Prof. Dr. Djordjevic Nebojsa, MD, PhD. Medical Faculty Nis, University of Nis, Serbia. Surgical Clinic, Clinical center Nis, Serbia
| | - Golubovic Ilija
- Dr. Golubovic Ilija MD. Surgical Clinic, Clinical center Nis, Serbia
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850
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Biomechanical property and modelling of venous wall. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2018; 133:56-75. [DOI: 10.1016/j.pbiomolbio.2017.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 11/18/2022]
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