scholarly journals Surgeons have hesitated early cholecystectomy because of cardiovascular comorbidities during adoption of guidelines

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Ichiro Onishi ◽  
Masato Kayahara ◽  
Takahisa Yamaguchi ◽  
Yukari Yamaguchi ◽  
Akihiko Morita ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Medical Center ◽  
Early Surgery ◽  
Early Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Cardiovascular Comorbidities ◽  
Group A ◽  
Delayed Group ◽  
Group B ◽  
Early Operations

AbstractThe introduction of the guidelines has resulted in an increase of laparoscopic surgeries performed, but the rate of early surgery was still low. Here, the initial effect of the introduction of the guideline was confirmed in single center, and factors disturbing early cholecystectomy were analyzed. This study included 141 patients who were treated for acute cholecystitis from January 2010 to October 2014 at Kanazawa Medical Center. Each patient was assigned into a group according to when they received treatment. Patients in Group A were treated before the Tokyo Guidelines were introduced (n = 48 cases), those in Group B were treated after the introduction of the guidelines (93 cases). After the introduction of the guidelines, early laparoscopic cholecystectomy was significantly increased (P < 0.001), however, the rate of early operations was still 38.7% only. There are many cases with cardiovascular disease in delayed group, the prevalence had reached 50% as compared with early group of 24% (P < 0.01). Approximately 25% of patients continued antiplatelet or anticoagulant therapy. In the early days of guidelines introduction, the factor which most disturbed early surgery was the coexistence of cardiovascular disease. These contents could be described in the next revision of the guidelines.

scholarly journals Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

2021 ◽  
Vol 15 (1) ◽  
pp. 91-94
Author(s):  
Muhammad Nasir ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Female Patients ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Group A ◽  
Male Patients ◽  
Group B

Background: Laparoscopic Cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill define. Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe Laparoscopic Cholecystectomy. Objective: To compare the early and delayed Laparoscopic Cholecystectomy in the acute phase in terms of frequency of conversion to open cholecystectomy. Study Design: Randomized clinical trial. Settings: Department of Surgery, Divisional Headquarter Hospital, Faisalabad. Punjab Medical College, Faisalabad Pakistan. Duration: Study was carried out over a period of six months from June 2018 to May 2019. Methodology: A total of 152 cases (76 cases in each group) were included in this study. All patients were randomly allocated to either group i.e., group -A early Laparoscopic Cholecystectomy and group-B delayed Laparoscopic Cholecystectomy. Results: Mean age was 39.09 + 8.8 and 37.05+ 8.5 years in group- A and B, respectively. In group-A, male patients were 48 (63.2%) and female patients were 28 (36.8%). Similarly, in group-B, male patients were 41 (53.9%) and female patients were 35 (46.1%). Conversion to open cholecystectomy was required in 6 patients (7.9%) of group-A and 16 patients (21.0%) of group – B. Significant difference between two groups was observed (P= 0.021). Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible in terms of less frequency of conversion to open cholecystectomy.

The impact of pretreatment absolute lymphocyte count (pALC) and neutrophil-lymphocyte ratio (pNLR) on checkpoint inhibitors (CPIs) response rates in renal cell carcinoma (RCC) and bladder urothelial cancers (BC).

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 29-29
Author(s):  
Tonjeh Mary Stella Bah ◽  
David Sommerhalder ◽  
Philip A. Haddad
Keyword(s):  
Checkpoint Inhibitors ◽  
Medical Center ◽  
Response Rates ◽  
Neutrophil Lymphocyte Ratio ◽  
Essential Components ◽  
Group A ◽  
Group 2 ◽  
Group B ◽  
The Impact ◽  
Group 1

31 Background: CPIs have been established as essential components of cancer immunotherapy across multiple cancer types with proven clinical benefit, improved outcomes, and less toxicity. Studies in lung and head and neck cancers found that low ALC, a marker of immune exhaustion, was associated with poor response to CPIs and worse progression-free survival. We explored the effect of pALC and pNLR on CPI response rates in patients with RCC and BC. Methods: We retrospectively reviewed every RCC and BC patient that received CPIs at Overton Brooks VA Medical Center and LSUHSC-S between 2015 and 2019. Patients’ pALC and pNLR were calculated. The patients were divided according to pALC into 2 groups: Group A with pALC > 1000 and Group B with pALC < 1000. Similarly, using NLR’s established upper normal limit of 3, 2 groups were created: Group 1 with pNLR < 3 and Group 2 with pNLR > 3. Our primary outcome of interest was defined as the presence or absence of CPI response. Patients who attained stable disease, partial response, and complete response were categorized as responders. Those who progressed on CPIs were labeled as non-responders. The significance of the association between pALC and pNLR groups and the occurrence of any response was analyzed statistically. Results: Twenty patients (13 RCC, 7 BC) were treated with CPIs and had documented responses. Twelve patients had pALC > 1000 (Group A) whereas 8 patients had pALC < 1000 (Group B). Both groups were comparable with respect to age, sex, race, and types of CPIs. Group A had a significantly higher response rate (75% vs 25%, p = 0.027). As to pNLR, 10 patients had pNLR < 3 (Group 1) and another 10 patients had pNLR > 3 (Group 2). Patients with pNLR > 3 had worse response rates to CPIs compared to those with pNLR < 3 (30% vs 80%, p = 0.024). Conclusions: This is the first report from a real-world clinical setting to show a detrimental association between pALC < 1000 and pNLR > 3 and CPI response rates in a retrospective cohort of consecutive non-selected kidney and bladder cancer patients. This association and its clinical utility require further confirmation in a prospective larger cohort.

scholarly journals Association between Respiratory Sleep Indices and Cardiovascular Disease in Sleep Apnea—A Community-Based Study in Cyprus

2020 ◽  
Vol 9 (8) ◽  
pp. 2475
Author(s):  
Frangiskos Frangopoulos ◽  
Ivi Nicolaou ◽  
Savvas Zannetos ◽  
Nicholas-Tiberio Economou ◽  
Tonia Adamide ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Heart Disease ◽  
Sleep Apnea ◽  
Ischemic Heart Disease ◽  
Supine Position ◽  
Ischemic Heart ◽  
Respiratory Event ◽  
Group A ◽  
Group B

Obstructive sleep apnea (OSA) is a chronic and prevalent disorder, strongly associated with cardiovascular disease (CVD). The apnea-hypopnea index (AHI), or respiratory event index (REI), and the oxygen desaturation index (ODI) are the clinical metrics of sleep apnea in terms of diagnosis and severity. However, AHI, or REI, does not quantify OSA-related hypoxemia and poorly predicts the consequences of sleep apnea in cardiometabolic diseases. Moreover, it is unclear whether ODI correlates with CVD in OSA. Our study aimed to examine the possible associations between respiratory sleep indices and CVD in OSA, in a non-clinic-based population in Cyprus. We screened 344 subjects of a stratified, total sample of 4118 eligible responders. All participants were adults (age 18+), residing in Cyprus. Each patient answered with a detailed clinical history in terms of CVD. A type III sleep test was performed on 282 subjects (81.97%). OSA (REI ≥ 15) was diagnosed in 92 patients (32.62%, Group A). REI < 15 was observed in the remaining 190 subjects (67.37%, Group B). In OSA group A, 40 individuals (43%) reported hypertension, 17 (18.5%) arrhythmias, 10 (11%) heart failure, 9 (9.8%) ischemic heart disease and 2 (2%) previous stroke, versus 46 (24%), 21 (11%), 7 (3.7%), 12 (6.3%) and 6 (3%), in Group B, respectively. Hypertension correlated with REI (p = 0.001), ODI (p = 0.003) and mean SaO2 (p < 0.001). Arrhythmias correlated with mean SaO2 (p = 0.001) and time spent under 90% oxygen saturation (p = 0.040). Heart failure correlated with REI (p = 0.043), especially in the supine position (0.036). No statistically significant correlations were observed between ischemic heart disease or stroke and REI, ODI and mean SaO2. The pathogenesis underlying CVD in OSA is variable. According to our data, hypertension correlated with REI, ODI and mean SaO2. Arrhythmias correlated only with hypoxemia (mean SaO2), whereas heart failure correlated only with REI, especially in the supine position.

scholarly journals Defibrillation threshold of internal cardioversion prior to ablation predicts atrial fibrillation recurrence

2020 ◽  
Author(s):  
kohei sawasaki ◽  
Yasuya Inden ◽  
natsuko hosoya ◽  
masahiro muto ◽  
Toyoaki Murohara
Keyword(s):  
Atrial Fibrillation ◽  
Medical Center ◽  
Defibrillation Threshold ◽  
Ablation Procedure ◽  
Recurrence Rates ◽  
Internal Cardioversion ◽  
Group A ◽  
Group B ◽  
Recurrence Method ◽  
Af Recurrence

Background: Many studies have reported the predictors of atrial fibrillation (AF) recurrence after persistent AF (peAF) ablation. However, the correlation between the atrial defibrillation threshold (DFT) for internal cardioversion (IC) and AF recurrence rate is little-studied. We investigated the relationship between DFT prior to catheter ablation for peAF and the AF recurrence. Method and Results: From June 2016 to May 2019, we enrolled 82 consecutive patients (mean age 65.0 ± 12.4 years), including 45 patients with peAF and 37 with long-standing peAF, at Hamamatsu medical center. In order to assess the DFT, we performed IC with gradually increasing energy prior to radiofrequency application. Forty-nine and 33 patients showed DFT values less than or equal to 10 J (group A) and greater than 10 J or unsuccessful defibrillation (group B), respectively. During the mean follow-up duration of 20.5 ± 13.1 months, patients in group B showed significantly higher AF recurrence rates than those in group A after the ablation procedure (P = 0.017). Multivariate analysis revealed that the DFT was the only predictive factor for AF recurrence (OR=1.07; 95% CI: 1.00-1.13, P = 0.047). Conclusions: The DFT for IC was one of the strongest prognostic factors in the peAF ablation procedure.

scholarly journals Evaluating the Efficacy and Trend of Sinus Surgery

2020 ◽  
Vol 24 (04) ◽  
pp. e407-e412
Author(s):  
Masa Petrovic ◽  
Arash Shamsian ◽  
Martin L. Hopp ◽  
Narine Vardanyan
Keyword(s):  
Medical Center ◽  
Preoperative Evaluation ◽  
Sinus Surgery ◽  
Surgical Results ◽  
Evaluation Time ◽  
Group A ◽  
Group B ◽  
Optimal Evaluation

Abstract Introduction From April 2009 to December 2016, 661 consecutive patients undergoing sinus surgery completed a quality of life (QOL) questionnaire (SNOT-22) preoperatively and at 3, 6, and 12 months postoperatively. Objective (1) To evaluate the long-term efficacy of sinus surgery using QOL instruments. (2) To determine the optimal evaluation time for surgical efficacy. (3) To determine if surgical results improve with yearly experience. Methods The prospective study patients were split into two groups: Group A, those who completed the initial preoperative evaluation and all postoperative evaluations, and Group B, who completed the preoperative questionnaire and at least one but not all of the postoperative questionnaires. Group A included 93 patients. Group B included 240 patients at 3 months, 180 at 6 months, and 121 at 12 months postoperatively. Results Group A efficacy reported at 3 months was 82.8%, 80.6% at 6 months, and 84.9% at 12 months postoperatively. Group B efficacy reported at 3 months was 71.3%, 78.3% at 6 months, and 84.3% at 12 months postoperatively. An 8-year trend analysis of year-to-year 12 months postoperative data illustrates a significant improvement with an analysis of variance (ANOVA) linear rate of 1.594 (p ≤0.12). Conclusion The 8-year trend at 12 months postoperatively shows a positive improvement in surgical results. Patients undergoing sinus surgery at tertiary medical center showed 84.9% improvement in sinus disease symptoms by 12 months postoperatively. Long-term improvement analysis showed no difference between 6 months postoperatively and 12 months, signifying 6 months as an effective evaluation for surgical efficacy.

DOES EARLY LAPAROSCOPIC CHOLECYSTECTOMY AFTER ERCP OFFERS SIGNIFICANT BENEFIT IN SURGICAL OUTCOME? A COMPARATIVE STUDY BETWEEN EARLY AND LATE GROUPS

2021 ◽  
pp. 59-61
Author(s):  
Anshul Mathur ◽  
Ketan Patel ◽  
Jitendra Kumar Mangtani ◽  
K.K. Dangayach
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Endoscopic Retrograde ◽  
Endoscopic Retrograde Cholangiopancreaticography ◽  
Early Laparoscopic Cholecystectomy ◽  
Conversion Rates ◽  
Group A ◽  
Group B

Introduction:- Endoscopic retrograde cholangiopancreaticography (ERCP) prior to Laparoscopic Cholecystectomy(LC) is most commonly practiced strategy worldwide for management of co-existing cholelithiasis with choledocholithiasis. The time interval between Endoscopic Retrograde Cholangiopancreaticography (ERCP) and Laparoscopic cholecystectomy (LC) is questionable and varies from 1 day to 6 weeks in different studies. Aims and objectives:- To compare two groups of patients managed with laparoscopic cholecystectomy (after ERCP), EARLY(24 to 72 hours), and LATE(> 6weeks) in terms of mean operative time in minutes, intraoperative difculties, conversion rates to open cholecystectomy, conversion rates to open cholecystectomy, drain insertion required or not, postoperative complications, and duration of hospital stay. Materials and methods:- A prospective randomized comparative study was conducted on 70 patients who presented with concomitant cholelithiasis with choledocholithiasis over a period of January 2019 to June 2020 at the Department of General Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur. After ERCP and stone retrieval patients were randomised into 2 groups using sealed envelope method. Group A underwent early laparoscopic cholecystectomy (24 to 72hours) and Group B underwent late laparoscopic cholecystectomy (after 6 weeks). Data collected, statistical analysis done, results and observations concluded. Result:- We found that mean operative time, intraoperative difculties, post operative complications and mean hospital stay in days were signicantly higher in Group B as compared to Group A. Though the conversion rates to open procedure and requirement of drain insertion were comparatively higher in Group B but were found to be statistically non signicant. Conclusion:- We hereby conclude that early laparoscopic cholecystectomy (24 to 72 hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP) is better as compared to late laparoscopic cholecystectomy (>6 weeks) after ERCP in patients of cholelithiasis with coexisting choledocholithiasis. So, we recommend performing early Laparoscopic Cholecystectomy (24-72hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP)

scholarly journals Parabolic relationship between plasma triacylglycerols and LDL-cholesterol in familial combined hyperlipidaemia: the multiple-type hyperlipidaemia explained?

2008 ◽  
Vol 114 (5) ◽  
pp. 393-401 ◽  
Author(s):  
Martijn C. G. J. Brouwers ◽  
Jacqueline de Graaf ◽  
Marleen M. J. van Greevenbroek ◽  
Anna M. Georgieva ◽  
Carla J. H. van der Kallen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Negative Relationship ◽  
Density Lipoprotein ◽  
Lipid Disorder ◽  
Parabolic Relationship ◽  
Group A ◽  
Group B ◽  
Multiple Type

FCHL (familial combined hyperlipidaemia) is a highly prevalent genetic lipid disorder that accounts for a substantial number of premature cardiovascular events. To date, FCHL has been complicated by the different lipid phenotypes that are present within one family and one individual patient over time. In the present study, we hypothesized that a parabolic relationship between plasma triacylglycerols (triglycerides) and LDL (low-density lipoprotein)-cholesterol can explain this so-called ‘multiple-type hyperlipidaemia’ in FCHL. Our hypothesis was tested in two well-documented FCHL cohorts [Maastricht (n=145) and Nijmegen (n=299)] that were followed over a 5-year interval. Three groups were constructed depending on plasma triacylglycerols: group A (individuals with both measurements below 1.5 mmol/l), group B (one measurement below and one measurement above 1.5 mmol/l) and group C (both measurement above 1.5 mmol/l). In both male, but not female, cohorts, a significant positive relationship between plasma triacylglycerols and LDL-cholesterol was observed in group A (P=0.02 for Maastricht cohort and P=0.001 for the Nijmegen cohort), a significant negative relationship in group C (P=0.01 for Maastricht cohort and P=0.02 for the Nijmegen cohort), and a relationship intermediate to group A and C in group B. In contrast, both apoB (apolipoprotein B) levels and the prevalence of cardiovascular disease were related with plasma triacylglycerols in a more linear fashion. In conclusion, a parabolic relationship between plasma triacylglycerols and LDL-cholesterol explains the ‘multiple-type hyperlipidaemia’ in FCHL. In addition, the linear relationship between triacylglycerols and both apoB levels and the prevalence of cardiovascular disease substantiate the use of apoB instead of LDL-cholesterol in the diagnosis of FCHL and the prediction of cardiovascular disease.

Role of Radiation Therapy in the Management of Meningioma

Neurosurgery ◽  
1982 ◽  
Vol 10 (3) ◽  
pp. 332-339 ◽  
Author(s):  
Richard J. Carella ◽  
Joseph Ransohoff ◽  
Joseph Newall
Keyword(s):  
Radiation Therapy ◽  
Tumor Necrosis ◽  
Medical Center ◽  
Case Reports ◽  
Primary Treatment ◽  
New York University ◽  
Group A ◽  
Group B

Abstract Surgery is the accepted form of treatment of meningioma; the role of radiotherapy has not been clearly established. With this in mind, we have reviewed our experience with radiation therapy in the management of meningiomas at New York University Medical Center. Sixty-eight patients fell into three groups. Forty-three (Group A) underwent operation followed by radiation therapy, 14 patients (Group B) had radiation for recurrence after operation, and 11 patients (Group C) had radiation therapy as the primary treatment. In Group A, 41 of 43 are alive. During a follow-up of 1 to 10 years, only 2 have deteriorated. Five of 14 Group B patients showed neurological improvement and 7 showed deterioration, including 5 who died of tumor. All 11 patients in Group C are alive with follow-up periods of 3 to 6 years; 9 of these show improvement in neurological function. Eleven patients had malignant meningioma, of whom 8 are alive and stable. We present 4 case reports, including computed tomographic scans that show evidence of tumor necrosis after radiation therapy. Pathological verification of tumor necrosis is presented in 1 case. We believe that radiation therapy has an established role in the treatment of incompletely excised, recurrent, or malignant meningiomas and, in some cases, as the initial management of meningiomas. Indications for treatment and guidelines are presented.

scholarly journals The prevalence of traditional risk factors for cardiovascular disease in the Omsk region: data of the ESSE-RF2 study

2020 ◽  
Vol 25 (6) ◽  
pp. 3815
Author(s):  
I. A. Viktorova ◽  
N. G. Shirlina ◽  
V. L. Stasenko ◽  
G. A. Muromtseva
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Alcohol Consumption ◽  
Abdominal Obesity ◽  
Positive Family History ◽  
Region Data ◽  
History Of ◽  
Group A ◽  
Traditional Risk Factors ◽  
Group B

Aim. To study the prevalence of some traditional risk factors for cardiovascular disease (CVD) in the Omsk region.Material and methods. The prevalence of traditional risk factors for CVD in a representative sample of the Omsk region population aged 25-64 years (n=1,648) was estimated as a part of the ESSE-RF2 study in 2017.Results. It was established that the mean age of CVD detection in the Omsk region is 46,3 years, the prevalence of overweight is 35,0%, obesity — 30,3%. Abdominal obesity was detected in 56,8% of subjects. Smoking was reveled in 21,2% of the population, former smoking — 20,0%. Alcohol consumption more than 2 times a month was observed in one third of respondents (30,5%). In the group of healthy people, compared with CVD patients, the percentage of smokers and alcohol consumers was detected significantly more often: smoking — 25,2±1,26% vs 17,1±0,86% and 32,9±1,6% vs 28,1±1,4%, respectively. Perhaps it was the diseases the reason for smoking cessation and alcohol abstinence among people with CVD. It should be noted that among 70% of alcohol consumers, both with/ without CVD, strong drinks were the preferred type of alcohol. Hypertension (HTN) was observed in 47,9% of subjects, and in 43,1% the diagnosis was verified. In 4,8% of HTN individuals, blood pressure increase was detected for the first time in this study. The prevalence of diabetes of both types in the Omsk region was 6,7%, and in group A (with CVD) it was much higher than in group B (without CVD): 10,7% vs 2,8%. Type 2 diabetes prevailed in people with CVD (p=0,000005). This was not characteristic of type 1 diabetes.Conclusion. The most common risk factors for CVD in the Omsk region population were HTN (47,9%), abdominal obesity (56,8%), a positive family history of early CVD (62,0%), alcohol consumption over the past 12 months (71,7%) and strong alcohol drinking (72,0%). However, a significant portion of the subjects (41,3%) consumed alcohol no more than 1 time per month.

scholarly journals Treatment of Cardiac Surgical Wounds with Silver Dressings

2021 ◽  
Vol 14 ◽  
pp. 269-272
Author(s):  
Ashlie Elver ◽  
Katy Wirtz ◽  
Jinxiang Hu ◽  
Emmanuel Daon
Keyword(s):  
Cardiac Surgery ◽  
Medical Center ◽  
Patient Characteristics ◽  
University Of Kansas ◽  
Surgical Wounds ◽  
Change In Practice ◽  
Group A ◽  
Sternal Wound Infections ◽  
Group B ◽  
The University

Introduction. Mediastinitis is a deadly surgical site infection (SSI) after cardiac surgery. Although rare, mortality is as high as 47%. Best practices for infection prevention to eliminate this deadly complication must be identified. Surgical dressings impregnated with silver have been shown to reduce SSIs in other surgical specialties. This aim of this study is to determine if the routine use of silver surgical dressings is beneficial to prevent mediastinitis after cardiac surgery. Methods. A single-center retrospective study was performed on patients who underwent sternotomy from 2016 to 2018 at the University of Kansas Medical Center. Prior to June 2017, all cardiac surgical patients were treated with gauze surgical dressings and is designated Group A. The routine use of silver-impregnated surgical dressings was implemented in June 2017, patients after this change in practice are designated Group B. Patient characteristics and rates of deep and superficial sternal wound infections (SWI) were compared.  Results. There were 464 patients in Group A and 505 in Group B. There were seven SWIs in Group A (7/464, 1.5%) and five in Group B (5/505, 1%; p = 0.57). Of these, there was one deep SWI per group (p = 0.61) and six superficial SWIs in Group A compared to four in Group B (p = 0.74). Severe COPD was higher in Group A (p = 0.04) and peak glucose was higher in Group B (p = 0.02).  Conclusions.The analysis conferred no benefit with silver-impregnated surgical dressings to prevent mediastinitis. Choice of gauze surgical dressings may be preferable to reduce cost.

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