scholarly journals Ineffective Esophageal Motility in Patients with GERD is no Contraindication for Nissen Fundoplication

2019 ◽  
Vol 44 (1) ◽  
pp. 186-193 ◽  
Author(s):  
Milena Nikolic ◽  
Katrin Schwameis ◽  
Ivan Kristo ◽  
Matthias Paireder ◽  
Aleksa Matic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Esophageal Motility ◽  
Nissen Fundoplication ◽  
Symptom Relief ◽  
Gastrointestinal Symptoms ◽  
Postoperative Outcome ◽  
Ineffective Esophageal Motility ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Patients with preoperative ineffective esophageal motility (IEM) are thought to be at increased risk for postoperative dysphagia leading to the recommendations for tailoring or avoiding anti-reflux surgery in these patients. The aim of this study was to evaluate if IEM has an influence on postoperative outcome after laparoscopic Nissen fundoplication (LNF). Methods Seventy-two consecutive patients with IEM underwent LNF and were case-matched with 72 patients without IEM based on sex, age, BMI, HH size, total pH percentage time, total number of reflux episodes and the presence of BE. Standardized interview assessing postoperative gastrointestinal symptoms, proton pump inhibitor intake, GERD-health-related-quality-of-life (GERD-HRQL), alimentary satisfaction and patients’ overall satisfaction was evaluated. Results Although a higher rate of preoperative dysphagia was observed in patients with IEM (29% IEM vs. 11% no IEM, p = 0.007), there was no significant difference in rates of dysphagia postoperatively (2 IEM vs. 1 no IEM, p = 0.559). Furthermore, no distinction was found in the postoperative outcome regarding symptom relief, quality of life, gas bloating syndrome, ability to belch and/or vomit or revision surgery between the two groups. Conclusion Although preoperative IEM has an influence on GERD presentation, it has no effect on postoperative outcome after LNF. IEM should not be a cause for avoiding LNF, as is has been shown as the most effective and safe anti-reflux treatment.

scholarly journals Expanded Indication for Magnetic Sphincter Augmentation: Outcomes in Weakly Acidic Reflux Compared to Standard GERD Patients

2021 ◽  
Author(s):  
Milena Nikolic ◽  
Aleksa Matic ◽  
Joy Feka ◽  
Lisa Gensthaler ◽  
Ivan Kristo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Morbidity ◽  
Gastrointestinal Symptoms ◽  
Postoperative Outcome ◽  
Magnetic Sphincter Augmentation ◽  
Comparable Group ◽  
Significant Difference ◽  
Related Quality

Abstract Background Magnetic sphincter augmentation (MSA) is a modern surgical anti-reflux technique with proven efficacy and low postoperative morbidity in patients with acidic reflux. The aim of this retrospective review study was to evaluate the symptomatic outcome of MSA in patients with weakly acidic reflux. Methods From a prospectively collected clinical database, comprising all 327 patients that underwent MSA at our institution, a total of 67 patients with preoperative weakly acidic reflux measured in the 24-h impedance-pH-metry were identified. Postoperative gastrointestinal symptoms, proton pump inhibitor intake (PPI), GERD Health-Related Quality-of-Life (GERD-HRQL), alimentary satisfaction (AS), and patients’ overall satisfaction were evaluated within highly standardized follow-up appointments. Furthermore, outcome of these patients was compared to the postoperative outcome of a comparable group of patients with a preoperative acidic reflux. Results At a median follow-up of 24 months, none of the patients with weakly acidic reflux presented with persistent dysphagia, or underwent endoscopic dilatation or reoperation. The postoperative GERD-HRQL score was significantly reduced (2 vs. 20; p = 0.001) and the median AS was 9/10. Preoperative daily heartburn, regurgitations, and respiratory complaints were improved in 95%, 95%, and 96% of patients, respectively. A total of 10% of the patients continued to use PPIs postoperatively. No significant difference was observed in terms of postoperative outcome or quality of life when comparing weakly acidic reflux patients with those diagnosed with preoperative acidic reflux. Conclusion Magnetic sphincter augmentation significantly improves GERD-related symptoms and quality of life in patients with weakly acidic reflux with very low postoperative morbidity.

scholarly journals Tiotropium (SPIRIVA®) in mild COPD: Is it worth it?

2019 ◽  
Vol 46 (1) ◽  
Author(s):  
Lina Mahmoud ◽  
Hannah Ng ◽  
Jade Roberts
Keyword(s):  
Quality Of Life ◽  
Exercise Duration ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Serious Adverse Events ◽  
Main Trial ◽  
Copd Exacerbations ◽  
Increased Risk ◽  
Significant Difference

Purpose:Tiotropium (SPIRIVA®) is used in the treatment of moderate to severe chronic obstructive pulmonary disease (COPD) in patients with persistent dyspnea despite using a short acting bronchodilator (SABD).This paper explores the role of tiotropium in the treatment of mild COPD. Methods:The Cochrane Library, EMBASE, Pubmed, and Clinicaltrials.gov were searched on February 2018.We included randomized controlled trials (RCTs) that evaluated tiotropium in patients with mild COPD.Three authors assessed studies for eligibility. Outcomes included symptoms, quality of life, exercise duration, lung function, COPD exacerbations and hospitalizations, and serious adverse events. Results: Three RCTs were selected as the best available evidence. Based on the results of the main trial, quality of life and symptoms were improved with tiotropium as compared to placebo with a difference between groups at 24 months to be 1.2 (95% CI: 0.5 to 1.9; p=0.0011) using the COPD Assessment test (CAT) score. Frequency of acute exacerbations of COPD (AECOPD) requiring hospitalization was reduced by 10.3% (28.9% with tiotropium vs 39.2% with placebo) in patients receiving tiotropium. One RCT reported no statistically significant difference in exercise duration (27 ± 27 secs) in the tiotropium group vs 50 ± 21 secs in the placebo group; (p=0.4153). Oropharyngeal discomfort was more common with tiotropium (number needed to harm of 12) compared to placebo. Conclusions: Evidence suggests that tiotropium may reduce COPD exacerbations and hospitalizations and improve quality of life in patients with mild COPD.There is an increased risk of oropharyngeal discomfort with tiotropium.

Perceived quality of life before and after implantation of an internal cardioverter defibrillator

1995 ◽  
Vol 4 (1) ◽  
pp. 36-43 ◽  
Author(s):  
EM Bainger ◽  
JI Fernsler
Keyword(s):  
Quality Of Life ◽  
Perceived Quality ◽  
Convenience Sample ◽  
Cardioverter Defibrillator ◽  
Perceived Quality Of Life ◽  
Increased Risk ◽  
Significant Difference ◽  
Before And After ◽  
Internal Cardioverter Defibrillator

BACKGROUND: Although use of the internal cardioverter defibrillator in selected high-risk patient groups has significantly improved survival, questions have arisen regarding its impact on psychological adjustment and quality of life. OBJECTIVES: To determine whether there was a difference in perceived quality of life of internal cardioverter defibrillator recipients before implantation, reported retrospectively, and after implantation. METHODS: Survey packets containing a demographic data form, a modified version of the Ferrans and Powers Quality of Life Index: Cardiac Version, and a consent form were mailed to internal cardioverter defibrillator recipients accrued from two hospitals; 70 patients comprised the convenience sample. RESULTS: No significant difference in perceived overall quality of life was revealed by before and after implantation scores of t tests or analyses of variance. Young, unemployed patients with multiple health problems were most at risk for quality of life deficits. Overall, recipients in this study appeared to adapt effectively to the stresses associated with the device. CONCLUSIONS: Our results suggest that the internal cardioverter defibrillator did not prolong life at a sacrifice to quality of life. These findings can help identify patients at increased risk for quality of life deficits.

Hypofractionated Palliative Radiotherapy (17 Gy per two fractions) in Advanced Non–Small-Cell Lung Carcinoma Is Comparable to Standard Fractionation for Symptom Control and Survival: A National Phase III Trial

2004 ◽  
Vol 22 (5) ◽  
pp. 801-810 ◽  
Author(s):  
Stein Sundstrøm ◽  
Roy Bremnes ◽  
Ulf Aasebø ◽  
Steinar Aamdal ◽  
Reidulv Hatlevoll ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Symptom Relief ◽  
Small Cell ◽  
Phase Iii ◽  
Life Questionnaire ◽  
Small Cell Lung ◽  
European Organization ◽  
Significant Difference

Purpose To investigate whether the effect of hypofractionated thoracic radiotherapy (TRT) is comparable to more standard fractionated radiotherapy (RT) in advanced non–small-cell lung cancer (NSCLC). Patients and Methods A total of 421 patients with locally advanced stage III or stage IV NSCLC tumors were included. Inclusion criteria were inoperable, disease too advanced for curative radiotherapy, and chest symptoms or central tumor threatening the airways. Patients were randomly assigned to three arms: A, 17 Gy per two fractions (n = 146); B, 42 Gy per 15 fractions (n = 145); and C, 50 Gy per 25 fractions (n = 130). Four hundred seven patients were eligible for the study; 395 patients (97%) participated in the health-related quality-of-life (HRQOL) study. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and EORTC QLQ-lung cancer–specific module (LC13) were used to investigate airway symptom relief and changes in HRQOL. Assessments were performed before TRT and until week 54. Clinicians' assessments of symptom improvement were at 2, 6, and 14 weeks after completion of TRT. The patients were observed for a minimum of 3 years. Results Baseline prognostic data were equally distributed in the treatment groups. Patient compliance with respect to the HRQOL investigation was minimum 74%. HRQOL and symptom relief were equivalent in the treatment arms. No significant difference in survival among arms A, B, and C was found, with median survival 8.2, 7.0, and 6.8 months, respectively. Conclusion Our data indicate that protracted palliative TRT renders no improvement in symptom relief, HRQOL, or survival when compared with short-term hypofractionated treatment in advanced NSCLC.

scholarly journals Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms

2017 ◽  
Vol 126 (5) ◽  
pp. 1514-1519 ◽  
Author(s):  
Madjid Samii ◽  
Hussam Metwali ◽  
Venelin Gerganov
Keyword(s):  
Quality Of Life ◽  
Vestibular Schwannoma ◽  
Symptom Relief ◽  
Vestibular Dysfunction ◽  
Control Group ◽  
Surgical Removal ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Vestibular Symptoms

OBJECTIVEThe aim of this study was to analyze the efficacy and risks of microsurgery via the hearing-preserving retrosigmoid approach in patients with intracanalicular vestibular schwannoma (VS) suffering from disabling vestibular symptoms, with special attention to vertigo.METHODSThis is a retrospective analysis of 19 patients with intracanalicular VS and disabling vestibular dysfunction as the main or only symptom (Group A). All of the patients reported having had disabling vertigo attacks. Subjective evaluation of the impairment of patients was performed before surgery, 3 weeks after surgery, 3 months after surgery, and 1 year after surgery, using the Dizziness Handicap Inventory (DHI). The main outcome measures were improvement in quality of life as measured using the DHI, and general and functional outcomes, in particular facial function and hearing. Patient age, preoperative tumor size, preoperative DHI score, and preservation of the nontumorous vestibular nerve were tested using a multivariate regression analysis to determine factors affecting the postoperative DHI score. The Mann-Whitney U-test was used to compare the postoperative DHI score at 3 weeks, 3 months, and 1 year after surgery with a control group of 19 randomly selected patients with intracanalicular VSs, who presented without vestibular symptoms (Group B). The occurrence of early postoperative discrete vertigo attacks was also compared between groups.RESULTSThe preoperative DHI score was ≥ 54 in all patients. All patients reported having had disabling rotational vertigo before surgery. The only significant factor to affect the DHI outcome 3 weeks and 3 months after surgery was the preoperative DHI score. The DHI outcome after 1 year was not affected by the preoperative DHI score. Compared with the control group, the DHI score at 3 weeks and 3 months after surgery was significantly worse. There was no significant difference between the groups after 1 year. Vertigo was improved in all patients and completely resolved after 1 year in 17 patients.CONCLUSIONSDisabling vestibular dysfunction that affects quality of life should be considered an indication for surgery, even in otherwise asymptomatic patients with intracanalicular VS. Surgical removal of the tumor is safe and very effective in regard to symptom relief. All patients had excellent facial nerve function within 1 year after surgery, with a very good chance of hearing preservation.

scholarly journals Mixed anxiety and depressive disorder outcomes: prospective cohort study in primary care

2011 ◽  
Vol 198 (6) ◽  
pp. 472-478 ◽  
Author(s):  
Kate Walters ◽  
Marta Buszewicz ◽  
Scott Weich ◽  
Michael King
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Depressive Disorder ◽  
Psychiatric Diagnosis ◽  
Short Form ◽  
General Health Questionnaire ◽  
Consultation Rate ◽  
Increased Risk ◽  
Significant Difference

BackgroundMixed anxiety and depressive disorder (MADD) is common yet ill-defined, with little known about outcomes.AimsTo determine MADD outcomes over 1 year.MethodWe recruited 250 adults attending seven London general practices with mild–moderate distress. Three groups were defined using a diagnostic interview: MADD, other ICD–10 psychiatric diagnosis, no psychiatric diagnosis. We assessed symptoms of distress (General Health Questionnaire–28), quality of life (12-item Short Form Health Survey), general practitioner (GP) diagnosis and consultation rate at baseline, 3 months and 1 year.ResultsTwo-thirds of participants with MADD had no significant psychological distress at 3 months (61%) or 1 year (69%). However, compared with those with no diagnosis, individuals had twice the risk of significant distress (incidence rate ratio 2.39, 95% CI 1.29–4.42) at 3 months but not 1 year, and persistently lower quality of life (mental health functioning). There was no significant difference in GP consultation rate/diagnosis.ConclusionsThe majority with MADD improved, but individuals had an increased risk of significant distress at 3 months and a lower quality of life. As we cannot currently predict those with a poorer prognosis these patients should be actively monitored in primary care.

scholarly journals The effect of group-based education on gastrointestinal symptoms and quality of life in patients with celiac disease: randomized controlled clinical trial

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Zahra Akbari Namvar ◽  
Reza Mahdavi ◽  
Masood Shirmohammadi ◽  
Zeinab Nikniaz
Keyword(s):  
Quality Of Life ◽  
Celiac Disease ◽  
Gastrointestinal Symptoms ◽  
Control Group ◽  
Post Intervention ◽  
Sf 36 ◽  
Gi Symptoms ◽  
Significant Difference ◽  
The Mean

Abstract Background In this trial, we investigated the effect of a group-based education program on gastrointestinal (GI) symptoms and quality of life (QOL) in patients with celiac disease (CD). Method In the present study, 130 patients with CD who were on a GFD for at least 3 months, randomly assigned to receive group-based education (n = 66) or routine education in the celiac clinic (n = 64) for 3 months. We assessed gastrointestinal symptoms and quality of life using the gastrointestinal symptom rating scale (GSRS) questionnaire and SF-36 questionnaire at baseline and 3 months after interventions. Results The mean age of the participants was 37.57 ± 9.59 years. There were no significant differences between the two groups regarding the baseline values. Results showed that the mean score of total GSRS score in the intervention group was significantly lower compared with the control group 3 months post-intervention (p = 0.04). Also, there was a significant difference in the mean score of SF-36 between the two groups 3 months post-intervention (p = 0.02). Conclusion Results showed that group-based education was an effective intervention in patients with celiac disease to improve gastrointestinal symptoms and quality of life. Trial registration IRCT code: IRCT20080904001197N21; registration date: 5/23/2019.

scholarly journals The efficacy and safety of silymarin in the treatment of chemotherapy-induced peripheral neuropathy, a randomized double-blinded clinical trial

2021 ◽  
Author(s):  
Ramin Shekarriz ◽  
Hojjat Ghorbani ◽  
Mahmoud Mousazadeh ◽  
Khatereh Vahedi ◽  
Ebrahim Salehifar
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Intervention Group ◽  
Gastrointestinal Symptoms ◽  
Treated Group ◽  
Control Group ◽  
Significant Difference ◽  
Eortc Qlq ◽  
Double Blinded

Aim: The aim of this study was to evaluate the efficacy and side effects of silymarin in the treatment of CIPN. Methods: Patients who referred to outpatient oncology department of a referral educational hospital affiliated to Mazandaran University of Medical Sciences and experienced CIPN were randomized to receive silymarin or placebo. Intervention group received 140 mg of the Silymarin twice daily accompanied and 300 mg/day Gabapentin, whereas control group received 300 mg/day of Gabapentin and placebo twice daily for 3 months. The grade of neuropathy was determined according to the CTCAE criterion. The improvement of neuropathy was defined as the reduction of at least one neuropathic score. The visual analogue scale (VAS) was used to assess the severity of patients’ pain and the EORTC-QLQ-C30 criterion was used to assess the quality of life. Patients were evaluated initially and at the follow up visit 3 months after the enrollment. Results: A total of 80 patients were enrolled in the study. There was no significant difference between the groups in terms of severity of neuropathy at baseline. At the end of the study, the number of people with improved neuropathy in the silymarin group was 82.8% patients, which was significantly higher than 48.4% observed in the patients received placebo (P= 0.005). The silymarin-treated group showed a significant reduction in pain compared with those receiving placebo. Despite the improvement in quality of life in the intervention group compared to the comparison group, this difference was not statistically significant. Gastrointestinal symptoms were the only reported side effects with a similar incidence in two groups. Conclusion: The present data demonstrate the potential clinical use of silymarin as an adjuvant therapy to reduce CIPN symptoms.

scholarly journals Tailored modern GERD therapy – steps towards the development of an aid to guide personalized anti-reflux surgery

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Milena Nikolic ◽  
Katrin Schwameis ◽  
Matthias Paireder ◽  
Ivan Kristo ◽  
Georg Semmler ◽  
...  
Keyword(s):  
Esophageal Motility ◽  
Decision Aid ◽  
Preoperative Evaluation ◽  
Gastrointestinal Symptoms ◽  
Postoperative Outcome ◽  
Treatment Decision ◽  
Short Term ◽  
Related Quality ◽  
Health Related

AbstractAs the incidence of gastroesophageal reflux disease (GERD) is rising, surgical treatment is continuously advancing in an effort to minimize side effects, whilst maintaining efficacy. From a database of patients that underwent anti-reflux surgery at our institution between 2015 and 2018, the last 25 consecutive patients that underwent electrical stimulation (ES), magnetic sphincter augmentation (MSA) and Nissen fundoplication (NF), following a personalized treatment decision aid, were included in a comparative analysis. After preoperative evaluation each patient was referred for an ES, MSA or NF based on esophageal motility, hiatal hernia (HH) size and the patients’ preferences. Postoperative gastrointestinal symptoms and GERD-Health-related-Quality-of-Life were assessed. Preoperatively the median DCI (299 ES vs. 1523.5 MSA vs. 1132 NF, p = 0.001), HH size (0.5 cm ES vs. 1 cm MSA vs. 2 cm NF, p = 0.001) and presence of GERD-related symptoms differed significantly between the groups. The highest rate of postoperative dysphagia was seen after MSA (24%, p = 0.04), while the median GERD HRQL total score was equally distributed between the groups. The positive short-term postoperative outcome and patient satisfaction indicate that such an aid in treatment indication, based on esophageal motility, HH size and patient preference, represents a feasible tool for an ideal choice of operation and an individualized therapy approach.

Endovascular Treatment of Cancer-Associated Venous Obstruction: Comparison of Efficacy Between Stent Alone and Stent Combined With Linear Radioactive Seeds Strand

2020 ◽  
Vol 54 (7) ◽  
pp. 565-572
Author(s):  
Bei Wu ◽  
Guowen Yin ◽  
Xu He ◽  
Guoping Chen ◽  
Boxiang Zhao ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Survival Time ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Symptom Relief ◽  
Venous Obstruction ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objectives: To investigate the safety and efficacy of a stent combined with a linear strand of 125I seeds to treat malignant cancer–associated venous obstruction. Methods: We retrospectively analyzed the data of 57 patients with malignant cancer–associated venous obstruction. Nineteen patients underwent the placement of a stent combined with a linear strand of 125I seeds (group A), and 38 patients underwent the placement of a bare stent (group B). The following parameters were compared between the 2 groups of patients: symptom relief rate, duration of venous patency, survival time, quality of life, and adverse events. Results: A total of 34 stents and 527 seeds were implanted in group A, while a total of 57 stents were implanted in group B. The surgery success rate was 96.5%, and no serious complication related to the surgery was reported. Symptoms of venous obstruction improved significantly after surgery. The score of group A decreased from 14.74 ± 0.562 points before surgery to 2.79 ± 1.357 points after surgery( P < .001), and the score of group B decreased from 13.79 ± 1.398 points before surgery to 5.55 ± 3.674 points after surgery ( P < .001). The patency rate of group A was significantly higher than that of group B at 1 to 6 months after surgery (100%, 84.2%, 68.4%, 63.2%, 36.8%, 21.1% vs 68.4%, 23.7%, 18.4%, 7.9%, 5.3%, 2.6%, respectively; P < .05). Before treatment, there was no statistically significant difference in the Karnofsky Performance Status (KPS) score between the groups ( P = .791). After 1 to 6 months of treatment, the KPS score was significantly higher in group A than in group B ( P = .013). The median patency duration in groups A and B was 125 days (95% CI: 80.018-169.982) and 35 days (95% CI: 20.501-49.499), respectively ( P < .001). The median survival time of group A was 155 days (95% CI: 110.406-199.594), and that of group B was 98 days (95% CI: 55.712-140.288; P = .325). Multivariate analysis showed that the implantation of a stent combined with a linear strand of 125I seeds and the KPS score (≥80 points) were independent factors of long-term patency after stent placement. Conclusions: The placement of a stent combined with a linear strand of 125I seeds is a safe and effective treatment for venous obstruction caused by malignant tumors. This treatment provides prolonged patency compared with the placement of bare stent, and while it does not significantly improve the survival time of patients, it can improve their quality of life.

Sign in / Sign up

Export Citation Format

Share Document