scholarly journals AngelChik Device Removal and Revisional Fundoplication

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Hannah Chase ◽  
Sotiris Mastoridis ◽  
Nicholas Maynard
Keyword(s):  
Surgical Intervention ◽  
Clinical Care ◽  
Surgical Techniques ◽  
Developed Countries ◽  
Late Complications ◽  
Biliary Leak ◽  
Proactive Approach ◽  
Uncertain Evidence ◽  
Lower Oesophagus ◽  
The Uk

Gastro-oesophageal reflux disease (GORD) is a common condition in developed countries with an increasing incidence in the UK, currently estimated at 5 per 1000 person-years. Risk factors for GORD include Helicobacter pylori infection, obesity, alcohol consumption, smoking and genetic predisposition.  Surgical management is performed in chronic, severe cases of GORD, refractory to medical management. There are a variety of interventional surgical techniques available and the patient in this case had placement of an AngelChik Device (AD) 30 years ago. This is now a historic device due to associated complications and this patient had it removed with revisional treatment of the patient’s GORD with Nissen Fundoplication. The patient experienced multiple post-surgical complications, namely biliary leak from the central port, pulmonary embolism and pneumonia. Following description of the case, this report will discuss the increasing incidence of late complications of AD and propose a proactive approach to these patients going forwards. It will also discuss the current uncertain evidence of a new surgical intervention called magnetic sphincter augmentation (MSA) of the lower oesophagus that has similar principles to the mechanism of an AD. From this it will emphasise that more stringent and worldwide collaboration is required when bringing a new medical device into clinical care.

Stent Embolism after Coronary Angiography: Case Report

2016 ◽  
Vol 19 (3) ◽  
pp. 110 ◽  
Author(s):  
Bahar Temur ◽  
Tolga Can ◽  
Anil Karaagac ◽  
Murat Ugur ◽  
Mehmet Kaplan ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Surgical Techniques ◽  
Arterial Embolization ◽  
Late Complications ◽  
Acute Ischemia ◽  
Endovascular Interventions ◽  
First Choice ◽  
Peripheral Arterial ◽  
Arteries And Veins

Endovascular interventions are widely performed of late; complications including stent embolism of arteries and veins, dislocation, or malposition of medical devices are frequently seen. Peripheral stent embolisms are generally asymptomatic, but when they cause acute ischemia or severe symptoms like claudication they must be removed. Stents can be removed not only with surgical techniques but also with endovascular maneuvers. In this case report, we state that in symptomatic peripheral arterial embolization cases, surgical intervention is the first choice for treatment due to the complexity and high risk of complications when using endovascular maneuvers.

scholarly journals FEATURES OF COLON DIVERTICULOSIS LATE COMPLICATIONS SURGICAL TREATMENT

2017 ◽  
Vol 9 (2) ◽  
pp. 121-124
Author(s):  
V P Zemlyanoy ◽  
B V Sigua ◽  
A V Nikiforenko ◽  
E L Latariya ◽  
K O Sharvadze ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diverticular Disease ◽  
Clinical Case ◽  
Surgical Intervention ◽  
Diagnostic Errors ◽  
Developed Countries ◽  
Late Complications ◽  
Wide Spread ◽  
Back Ground ◽  
Colon Diverticulosis

Diverticular disease of the colon is frequent bowel disease. Wide spread of this pathol- ogy, especially among elderly patients, is caused by characteristics of the diet in developed countries. In modern conditions the clinician is faced with the complicated forms of diverticular disease, in some cases requiring urgent surgical intervention. However, the frequency of diagnostic errors on the back- ground of complicated diverticular disease can reach significant values. A clinical case, indicating the significant difficulties, appearing while diagnosis and surgical treatment of diverticular disease late complications is exampled.

Thrombolysis in Arterial Occlusion

1999 ◽  
Vol 82 (S 01) ◽  
pp. 109-111 ◽  
Author(s):  
Raymond Verhaeghe
Keyword(s):  
Clinical Practice ◽  
Thrombolytic Therapy ◽  
Hemorrhagic Stroke ◽  
Surgical Intervention ◽  
Bypass Graft ◽  
Surgical Techniques ◽  
Arterial Occlusion ◽  
Second Step ◽  
Severe Bleeding ◽  
Initial Management

SummaryIntra-arterial thrombolytic therapy has replaced systemic intravenous infusion of thrombolytic agents as a treatment modality for arterial occlusion in the limbs. Several catheter-guided techniques and various infusion methods and schemes have been developed. At present there is no scientific proof of definite superiority of any agent in terms of efficacy or safety but clinical practice favours the use of urokinase or alteplase. Studies which compared thrombolysis to surgical intervention suggest that thrombolytic therapy is an appropriate initial management in patients with acute occlusion of a native leg artery or a bypass graft. Underlying causative lesions are treated in a second step by endovascular or open surgical techniques. Severe bleeding is the most feared complication: the risk of hemorrhagic stroke is 1-2%.

Endoscopic sphenoidotomy

ORL ro ◽  
2016 ◽  
Vol 2 (1) ◽  
pp. 34-36
Author(s):  
I. Bulescu ◽  
C. Ioniţă ◽  
A. Coman ◽  
A. Panfiloiu ◽  
Andreea Nicoleta Costache ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Surgical Techniques ◽  
Endoscopic Technique ◽  
Detailed Knowledge

Given the progress of endoscopic surgical techniques detailed knowledge of nasosinusal local anatomy is an essential clinical request for surgeons. In this paper, the aim of the authors is to illustrate the surgical endoscopic technique of sphenoidotomy and to provide a step-by-step description of the main stages  of the surgical intervention.  

scholarly journals Protocol for a qualitative study to identify strategies to optimise hospital ePrescribing systems

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e044622
Author(s):  
Catherine Heeney ◽  
Stephen Malden ◽  
Aziz Sheikh
Keyword(s):  
Qualitative Interviews ◽  
Geographical Area ◽  
Health Resources ◽  
Round Table ◽  
Developed Countries ◽  
Care Quality ◽  
Electronic Prescribing ◽  
Study Results ◽  
Electronic Health ◽  
The Uk

IntroductionElectronic prescribing (ePrescribing) is a key area of development and investment in the UK and across the developed world. ePrescribing is widely understood as a vehicle for tackling medication-related safety concerns, improving care quality and making more efficient use of health resources. Nevertheless, implementation of an electronic health record does not itself ensure benefits for prescribing are maximised. We examine the process of optimisation of ePrescribing systems using case studies to provide policy recommendations based on the experiences of digitally mature hospital sites.Methods and analysisQualitative interviews within six digitally mature sites will be carried out. The aim is to capture successful optimisation of electronic prescribing (ePrescribing) in particular health systems and hospitals. We have identified hospital sites in the UK and in three other developed countries. We used a combination of literature reviews and advice from experts at Optimising ePrescribing in Hospitals (eP Opt) Project round-table events. Sites were purposively selected based on geographical area, innovative work in ePrescribing/electronic health (eHealth) and potential transferability of practices to the UK setting. Interviews will be recorded and transcribed and transcripts coded thematically using NVivo software. Relevant policy and governance documents will be analysed, where available. Planned site visits were suspended due to the COVID-19 pandemic.Ethics and disseminationThe Usher Research Ethics Group granted approval for this study. Results will be disseminated via peer-reviewed journals in medical informatics and expert round-table events, lay member meetings and the ePrescribing Toolkit (http://www.eprescribingtoolkit.com/)—an online resource supporting National Health Service (NHS) hospitals through the ePrescribing process.

scholarly journals General Paediatric Surgical Provision of Percutaneous Endoscopic Gastrostomy in a District General Hospital – A 12-Year Experience

2009 ◽  
Vol 91 (5) ◽  
pp. 404-409 ◽  
Author(s):  
T Sathesh-Kumar ◽  
Hazel Rollins ◽  
Sarah Cheslyn-Curtis
Keyword(s):  
General Hospital ◽  
Percutaneous Endoscopic Gastrostomy ◽  
District General Hospital ◽  
Late Complications ◽  
General Anaesthetic ◽  
Paediatric Surgery ◽  
Number Of Children ◽  
Endoscopic Gastrostomy ◽  
Local Access ◽  
The Uk

INTRODUCTION A small, but significant, number of children require long-term nutritional support. The aim of this study was to demonstrate the safety and efficacy of providing a percutaneous endoscopic gastrostomy (PEG) service for children in a district general hospital and to raise awareness of the suitability of the procedure to be performed on paediatric surgery lists in similar hospitals across the UK. PATIENTS AND METHODS A multidisciplinary paediatric nutrition team was established and all children accepted for PEG insertion between 1995 and 2007 were entered onto a database prospectively and are included in this study. PEG tubes were inserted by the standard pull-through technique under general anaesthetic. RESULTS A total of 172 procedures were performed in 76 children. The median age at first tube insertion was 3 years (range, 0.5–18 years). Length of follow-up ranged from 1 month to 12.6 years. Fifty-eight children (76%) had a neurological abnormality, the commonest being cerebral palsy. All but one procedure were performed successfully, of which 63 (37%) were new insertions, 99 change of tube, 4 changed from surgical gastrostomy and 6 from PEG to button gastrostomy. The median hospital stay was 2 days (range, 2–7 days) for new insertions and 1 day for tube changes. There were 10 (6%) early complications within 30 days, the commonest being peritubal infection (6). The 39 late complications included 16 peritubal infection/granulomata, 9 ‘buried bumpers’, 4 worsening of gastro-oesophageal reflux disease, 2 gastrocolic fistulae, 3 gastrocutaneous fistulae and 4 tubal migration. There was no mortality. CONCLUSIONS We have demonstrated that paediatric PEG procedures and continuing management by a supporting team can be successfully and efficiently provided in the district general hospital. It should be possible for the majority of similar hospitals to provide local access and increase the availability of PEG feeding for children.

scholarly journals Management of Hypertension: A Bangladeshi Perspective

1970 ◽  
Vol 39 (1) ◽  
pp. 40-43
Author(s):  
SM Mustafa Zaman ◽  
Mohammad Salman ◽  
Kaniz Fatema
Keyword(s):  
Cardiovascular Disease ◽  
Fruits And Vegetables ◽  
Lifestyle Modification ◽  
Clinical Care ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Lifestyle Changes ◽  
Optimum Level ◽  
Lifestyle Modifications

Hypertension is a silent killer. Bangladeshis are racially predisposed to cardiovascular disease, and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure is a continuum and any increase above optimum level confers additional independent risk of cardiovascular disease. We review screening, diagnosis and management using lifestyle measures and pharmacotherapy. We then discuss the barriers and challenges to implementing this approach and what can be done regarding prevention, screening, lifestyle modification and pharmacotherapy in our country. By adopting a comprehensive population based approach including policy level interventions directed at promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt and rich in fruits and vegetables), increased physical activity, and a smoking free society, properly balanced with a high risk approach of cost effective clinical care, Bangladesh can effectively control hypertension and improve public health. DOI: 10.3329/bmj.v39i1.6232 Bangladesh Medical Journal 2010; 39(1): 40-43

scholarly journals Musculoskeletal Tuberculosis in Bradford – A 6-Year Review

2007 ◽  
Vol 89 (4) ◽  
pp. 405-409 ◽  
Author(s):  
JC Talbot ◽  
Q Bismil ◽  
D Saralaya ◽  
DAG Newton ◽  
RM Frizzel ◽  
...  
Keyword(s):  
At Risk ◽  
World Wide ◽  
Surgical Intervention ◽  
Indian Subcontinent ◽  
Anatomical Site ◽  
At Risk Populations ◽  
Recorded Data ◽  
The Uk ◽  
Ethnic Distribution ◽  
Radiological Intervention

INTRODUCTION Tuberculosis (TB) remains the most common cause of death from infectious disease world-wide. In the UK, the incidence of TB has risen by 25% over the last 10 years; extrapulmonary diagnosis remains challenging and can be delayed. This study evaluates the epidemiology of musculoskeletal tuberculosis in a large multi-ethnic UK city. PATIENTS AND METHODS A review of prospectively recorded data of incidence, anatomical site, ethnic distribution, treatment and drug resistance of musculoskeletal tuberculosis over a 6-year period was performed. RESULTS From January 1999 to December 2004, there were 729 TB notifications; 61 cases (8.4%) had musculoskeletal involvement. Of the patients, 74% were immigrants from the Indian subcontinent; nearly 50% had spinal involvement; 24 patients underwent surgical intervention; 29 were subjected to either diagnostic or therapeutic radiological intervention; and resolution of symptoms was achieved in 59 out of 61 cases. CONCLUSIONS This study highlights the high proportion of musculoskeletal TB in immigrant patients in an area with a relatively large at-risk population, but will also serve to alert physicians, in areas with smaller at-risk populations, of the possibility of musculoskeletal TB.

scholarly journals Trends in surgical and catheter interventions for isolated congenital shunt lesions in the UK and Ireland

Heart ◽  
2019 ◽  
Vol 105 (14) ◽  
pp. 1103-1108 ◽  
Author(s):  
Mehreen Farooqi ◽  
John Stickley ◽  
Rami Dhillon ◽  
David J Barron ◽  
Oliver Stumper ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Surgical Techniques ◽  
Foramen Ovale ◽  
Patient Age ◽  
Surgical Interventions ◽  
Patient Âgé ◽  
Duct Ligation ◽  
The Uk

ObjectiveTo evaluate time trends in the use of catheter and surgical procedures, and associated survival in isolated congenital shunt lesions.MethodsNationwide, retrospective observational study of the UK National Congenital Heart Disease Audit database from 2000 to 2016. Patients undergoing surgical or catheter procedures for atrial septal defect (including sinus venosus defect), patent foramen ovale, ventricular septal defect and patent arterial duct were included. Temporal changes in the frequency of procedures, and survival at 30 days and 1 year were determined.Results40 911 procedures were performed, 16 604 surgical operations and 24 307 catheter-based interventions. Transcatheter procedures increased over time, overtaking surgical repair in 2003–2004, while the number of operations remained stable. Trends in interventions differed according to defect type and patient age. Catheter closure of atrial septal defects is now more common in children and adults, although surgical interventions have also increased. Patent foramen ovale closure in adults peaked in 2009–2010 before falling significantly since. Surgery remains the mainstay for ventricular septal defect in infants and children. Duct ligation is most common in neonates and infants, while transcatheter intervention is predominant in older children. Excluding duct ligation, survival following surgery was 99.4% and ≈98.7%, and following catheter interventions was 99.7% and ≈99.2%, at 30 days and 1 year, respectively.ConclusionsTrends in catheter and surgical techniques for isolated congenital shunt lesions plot the evolution of the specialty over the last 16 years, reflecting changes in clinical guidelines, technology, expertise and reimbursement, with distinct patterns according to lesion and patient age.

scholarly journals Impact of Ownership Structure on Bank Profitability in Nigeria

2008 ◽  
Vol 4 (3) ◽  
pp. 170-183
Author(s):  
Uhomoibhi Aburime Toni
Keyword(s):  
Emerging Markets ◽  
Ownership Structure ◽  
Developed Countries ◽  
Bank Profitability ◽  
Limited Applicability ◽  
The Usa ◽  
The Individual ◽  
The Uk ◽  
Finance Theory ◽  
Political Economic

Ownership structure is considered an important factor that affects a firm’s health. If ownership structure affects a firm’s health, it is possible then to use the ownership structure to predict firm profitability. Against this backdrop, this paper analyzes the relationship between ownership structure and bank profitability in Nigeria. There are two motivations for this paper. Firstly, midway into the banks consolidation exercise in Nigeria, the CBN identified the need for a determination of the most appropriate composition of bank capitalization that would enhance the individual and systemic profitability and efficiency of banks in Nigeria post-consolidation. Hence, it decided to minimize state governments’ investment in banks during the exercise and also issued a December 2007 ultimatum to all tiers of governments that have stakes in banks to dilute their investments to a maximum of 10 per cent. Unfortunately, the CBN did not state any econometrically-based rationale giving credence to its directives. Secondly, the effect of ownership structure and concentration on a firm’s performance is an important issue in the literature of finance theory. However, no researcher has studied this important aspect of finance theory in the Nigerian context. It is worth noting that most research on ownership structure and firm performance has been dominated by studies conducted in developed countries. However, there is an increasing awareness that theories originating from developed countries such as the USA and the UK may have limited applicability to emerging markets. Emerging markets have different characteristics such as different political, economic and institutional conditions, which limit the application of developed markets’ empirical models.

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