scholarly journals Peroral cholangioscopy by SpyGlass DS versus CHF-B260 for evaluation of the lateral spread of extrahepatic cholangiocarcinoma

2018 ◽  
Vol 06 (11) ◽  
pp. E1349-E1354 ◽  
Author(s):  
Yoshihide Kanno ◽  
Shinsuke Koshita ◽  
Takahisa Ogawa ◽  
Kaori Masu ◽  
Hiroaki Kusunose ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Lateral Spread ◽  
Extrahepatic Cholangiocarcinoma ◽  
Peroral Cholangioscopy ◽  
Guided Biopsy ◽  
Group A ◽  
Lateral Extent ◽  
Group B ◽  
Spyglass Ds ◽  
Mapping Biopsy

Abstract Background and study aims A newly developed peroral cholangioscopy (POCS) system, SpyGlassDS has high maneuverability. This study aimed to evaluate acceptability of the accuracy of SpyGlassDS accompanied by simultaneous POCS-guided biopsy compared with that of a traditional POCS scope, CHF-B260, to diagnose the lateral extent of extrahepatic cholangiocarcinoma (LEC). Patients and methods Patients who underwent surgical resection after preoperative examinations to diagnose LEC were evaluated. POCS by CHF-B260 was performed if there was discrepancy between preceding fluoroscopy-guided biopsy findings and other examinations between January 2004 and September 2015 (group A, n = 56); and POCS plus POCS-guided mapping biopsy by SpyGlassDS was performed in all surgical candidates between October 2015 and December 2017 (group B, n = 20). The main outcome measure was the accuracy of overall preoperative diagnosis (OPD) of LEC defined based on all examinations, including POCS. Results Accuracy of OPD for the liver side and the ampullary side was 93 % and 100 %, respectively, in group A, and 84 % and 100 %, respectively, in group B (P = 0.37 for the liver side; P, not available for the ampullary side). Diagnostic accuracy of simple optical evaluation by POCS for the liver side and the ampullary side was 83 % and 100 %, respectively, in group A, and 58 % and 88 %, respectively, in group B (P = 0.29 for the liver side; P = 0.40 for the ampullary side). Conclusions POCS by SpyGlassDS was found to be acceptable and could be a standard approach for diagnosis of LEC.

scholarly journals Sa1300 PERORAL CHOLANGIOSCOPY BY SPYGLASS DS VERSUS CHF-B260 FOR EVALUATION OF THE LATERAL SPREAD OF EXTRAHEPATIC CHOLANGIOCARCINOMA

2018 ◽  
Vol 87 (6) ◽  
pp. AB202-AB203
Author(s):  
Yoshihide Kanno ◽  
Takahisa Ogawa ◽  
Shinsuke Koshita ◽  
Kaori Masu ◽  
Hiroaki Kusunose ◽  
...  
Keyword(s):  
Lateral Spread ◽  
Extrahepatic Cholangiocarcinoma ◽  
Peroral Cholangioscopy ◽  
Spyglass Ds

scholarly journals Usefulness of cholangioscopic-guided mapping biopsy using SpyGlass DS for preoperative evaluation of extrahepatic cholangiocarcinoma: a pilot study

2018 ◽  
Vol 06 (02) ◽  
pp. E199-E204 ◽  
Author(s):  
Takahisa Ogawa ◽  
Kei Ito ◽  
Shinsuke Koshita ◽  
Yoshihide Kanno ◽  
Kaori Masu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Diagnostic Accuracy ◽  
Bile Duct Carcinoma ◽  
Preoperative Evaluation ◽  
Extrahepatic Cholangiocarcinoma ◽  
Duct Carcinoma ◽  
The Right ◽  
Spyglass Ds ◽  
Tumor Extent ◽  
Mapping Biopsy

Abstract Background and study aims Evaluation of longitudinal tumor extent is indispensable for curative surgical treatment of extrahepatic cholangiocarcinoma. The aim of this study was to evaluate the usefulness and feasibility of cholangioscopic-guided mapping biopsy using a newly developed peroral digital cholangioscope, SpyGlass DS (SpyDS), for preoperative evaluation of extrahepatic cholangiocarcinoma. Patients and methods Thirteen patients (mean age, 75 years; male 10, female 3) with extrahepatic cholangiocarcinoma who underwent cholangioscopic-guided mapping biopsy using SpyDS for preoperative evaluation were included in this study. Successful cholangioscopic-guided mapping biopsy was defined as the acquisition of specimens sufficient for histopathological diagnosis. Results The mean number of biopsies was 5 per patient. The overall success rate for cholangioscopic-guided mapping biopsy was 88 % (59/67). The success rate for cholangioscopic-guided mapping biopsy from the confluence of the right and left hepatic ducts was 89 %, that from the B4 confluence was 93 %, that from the confluence of the right anterior and right posterior segmental ducts was 86 %, that from the intrapancreatic common bile duct was 67 %, and that from the main lesion was 100 %. The overall diagnostic accuracy of longitudinal tumor extent at the hepatic side, the duodenal side and overall by cholangioscopic findings and mapping biopsy, was 88 % (7/8), 88 % (7/8) and 88 % (7/8), respectively. Assessment according to location of the main lesion revealed that diagnostic accuracy in the patients with distal bile duct carcinoma was 100 % (5/5) and that in patients with perihilar bile duct carcinoma was 66 % (2/3). Complications after the procedure did not occur in any patients. Conclusions Cholangioscopic-guided mapping biopsy using SpyDS is thought to be feasible for preoperative evaluation of extrahepatic cholangiocarcinoma.

scholarly journals Comparative effectiveness of simultaneous administration of mifepristone and misoprostol versus interval regimen of mifepristone followed by misoprostol 12 hours apart in second trimester medical abortion

2018 ◽  
Vol 7 (6) ◽  
pp. 2449
Author(s):  
Arunima Saini ◽  
Preet Kamal Bedi ◽  
Nisha Bhagat
Keyword(s):  
Gestational Age ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Simultaneous Administration ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Group A ◽  
Second Trimester Abortion ◽  
Vaginal Misoprostol ◽  
Group B

Background: In second trimester abortion, medical methods are preferred. Prostaglandins are the most widely used. Amongst them, misoprostol is the most commonly used. Thus, the study was conducted to delineate the effectiveness of simultaneous administration of mifepristone and misoprostol versus interval regimen mifepristone followed by misoprostol 12 hours apart in second trimester medical abortion.Methods: It was a prospective, single centered, comparative study conducted on 50 patients in Department of Obstetrics and Gynaecology, GMC, Amritsar coming for second trimester abortion, either elective or emergency, with gestational age between 12-20 weeks. Initially, 53 patients were enrolled in the study, 3 patients dropped out at different stages of study. Finally, 50 patients were enrolled and divided into two groups of 25 patients each by 1:1 randomization. In Group-A, mifepristone 200 mg orally along with misoprostol 600µg vaginally were given simultaneously, followed by 400 µg vaginal misoprostol every 4 hours for a maximum of five doses in 24 hours. Group-B initially received mifepristone 200 mg per oral followed by 12 hours later misoprostol 400µg vaginally and then 400µg vaginal misoprostol every 4 hours for a maximum of five doses in 24 hours. Primary outcome measure was effectiveness of regimen in complete abortion, which was confirmed on pelvic ultrasound 1-week after the last dose. Secondary outcome measure was to compare the induction abortion interval (IAI), dose of misoprostol required and adverse drug reaction (ADR) among both the regimens. P-value <0.05 was taken as statistically significant.Results: Mean age in Group-A was 25.68±3.79 years while in Group-B was 23.40±2.73 years. Both the regimens had success rate of 76% for complete abortion. However, IAI in Group-A was 5.9±4.47 hours whereas in Group-B was 9.6±5.07 hours, which was statistically significant (p= 0.009). A statistically significant difference was also observed in the mean dose of misoprostol between two groups that is, 1000±200µg and 1425±437.41µg respectively (p=0.01). Gestational age was related to IAI from 13 to 17.6 weeks in both groups (p=0.01) while no significant relation was seen between them in more than 17.6 weeks of gestation (p=0.63).Conclusions: Simultaneous administration of mifepristone and misoprostol showed better results than interval regimen in term of significant lesser induction abortion interval, lower dosages of misoprostol required with comparable success rates.

Microvascular decompression for hemifacial spasm: can intraoperative lateral spread response monitoring improve surgical efficacy?

2018 ◽  
Vol 128 (3) ◽  
pp. 885-890 ◽  
Author(s):  
Yongxu Wei ◽  
Wenlei Yang ◽  
Weiguo Zhao ◽  
Chunhua Pu ◽  
Ning Li ◽  
...  
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Lateral Spread ◽  
Response Monitoring ◽  
Cut Elimination ◽  
Clear Cut ◽  
Significant Difference ◽  
Group A ◽  
Lateral Spread Response ◽  
Group B

OBJECTIVEThe purpose of this study was to evaluate whether intraoperative monitoring of lateral spread response (LSR) improves the efficacy of microvascular decompression (MVD) for hemifacial spasm (HFS).METHODSIn this prospective study, patients undergoing MVD for HFS were assigned to one of 2 groups, Group A (MVD with intraoperative LSR monitoring) or Group B (MVD without LSR monitoring). Clinical outcome at 12 months after surgery was assessed through telephone survey. Data analysis was performed to investigate the effect of intraoperative LSR monitoring on efficacy of MVD.RESULTSA total of 283 patients were enrolled in the study, 145 in Group A and 138 in Group B. There was no statistically significant difference between the 2 groups with respect to the percentage of patients who had spasm relief at either 1 week (Group A 87.59% vs Group B 83.33%; p = 0.317) or 1 year (93.1% vs 94.2%; p = 0.809) after surgery. A clear-cut elimination of LSR during surgery was observed in 131 (90.34%) of 145 patients; LSR persisted in 14 patients (9.66%) at the end of the surgical procedure. Disappearance of LSR correlated with spasm-free status at 1 week postoperatively (p = 0.017) but not at 1 year postoperatively (p = 0.249).CONCLUSIONSIntraoperative LSR monitoring does not appear to provide significant benefit with respect to the outcome of MVD for HFS in skilled hands. Persistence of LSR does not always correlate with poor outcome, and LSR elimination should not be pursued in all patients after verification of complete decompression.

scholarly journals EFFICACY OF OTAGO EXERCISE VERSUS BOSU BALL EXERCISE IN BALANCE-IMPAIRED ELDERLY PEOPLE

2020 ◽  
pp. 25-28
Author(s):  
PAVITHRALOCHANI V ◽  
REBECCA SANDHIYA D ◽  
VIJAY P ◽  
MAJITHA PARVEEN M
Keyword(s):  
Elderly People ◽  
Outcome Measure ◽  
Treatment Protocol ◽  
Balance Training ◽  
Rest Period ◽  
P Value ◽  
Age Group ◽  
Geriatric Population ◽  
Group A ◽  
Group B

Objective: The objective of this study was to compare the effect of OTAGO exercise and BOSU ball exercise on balance training among geriatric population. Geriatric indicates the elderly people with age group more than 60. Balance is the state of equilibrium; three sensors drive a sense of balance (vision, proprioception, and vestibular). As the age increases, there will be some degenerative changes, the loss of any one of these systems affects balance which may result in falls and increased morbidity. The study focuses on the effectiveness of OTAGO exercise and BOSU ball exercise in elderly people. Methodology: Thirty subjects were selected and divided into two groups based on selection criteria with age group between 60-70, both male and female, people who scored 35–45 in Berg balance scale (BBS) grading test and four in fall risk assessment questionnaire was included and people with recent fracture and surgery, stroke, parkinson’s disease, psychiatric illness, severe pain, and muscle weakness were excluded from the study. Pre-test was done using BBS as an outcome measure, proceeding with treatment protocol; Group A: received BOSU ball exercise (unilateral heel raise, one leg stand, knee bend, split stance with torso rotation, and marching) for 30 min – each set of exercise was given for 5–8 repetition with rest period of 2 min. Group B received OTAGO exercise (Backward walking, sideways walking, toe walking, sit to stand, and one leg stand) for 30 min – each set of exercise was given for 5–8 repetition with rest period of 2 min. After the cessation of the treatment protocol, post-test was done using the same outcome measure. Results: Result of the study proves that each group shows p value (p≤0.001); however, Group A (BOSU ball exercise) shows more significant improvement than Group B (OTAGO exercise). Conclusion: Conclusion of the study shows that both BOSU ball exercise and OTAGO exercise were effective in improving balance among elderly people. However, BOSU ball exercise was better than OTAGO exercise in improving balance among elderly people.

scholarly journals Prognostic ability of intraoperative electromyographic monitoring during microvascular decompression for hemifacial spasm to predict lateral spread response outcome

2017 ◽  
Vol 126 (2) ◽  
pp. 391-396 ◽  
Author(s):  
Sung Ho Lee ◽  
Bong Jin Park ◽  
Hee Sup Shin ◽  
Chang Kyu Park ◽  
Bong Arm Rhee ◽  
...  
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Prognostic Value ◽  
University Hospital ◽  
Lateral Spread ◽  
Symptom Duration ◽  
Group A ◽  
Lateral Spread Response ◽  
Group B

OBJECTIVE Abnormal lateral spread response (LSR) is a typical finding in facial electromyography (EMG) in patients with hemifacial spasm (HFS). Although intraoperative monitoring of LSR has been widely used during microvascular decompression (MVD), the prognostic value of this monitoring is still debated. The purpose of this study was to determine whether such monitoring exhibits prognostic value for the alleviation of LSR after treatment of HFS. METHODS Between January 2009 and December 2013, a total of 582 patients underwent MVD for HFS with intraoperative EMG monitoring at Kyung Hee University Hospital. The patients were categorized into 1 of 2 groups according to the presence of LSR at the conclusion of surgery (Group A, LSR free; Group B, LSR persisting). Patients were assessed for the presence of HFS 1 day, 6 months, and 1 year after surgery. Various parameters, including age, sex, symptom duration, offending vertebral artery, and offending perforating artery, were evaluated for their influence on surgical and electrophysiological results. RESULTS Overall, HFS was alleviated in 455 (78.2%) patients 1 day after MVD, in 509 (87.5%) patients 6 months after MVD, and in 546 (93.8%) patients 1 year after MVD. Patients in Group B were significantly younger than those in Group A (p = 0.022). Patients with a symptom duration of less than 1 year were significantly more likely to be classified in Group A than were patients whose symptoms had persisted for longer than 10 years (p = 0.023); however, analysis of the entire range of symptom durations did not reveal a significant effect (p = 0.132). A comparison of Groups A and B according to follow-up period revealed that HFS recovery correlated with LSR alleviation over a shorter period, but the same was not true of longer periods; the proportions of spasm-free patients were 80.6% and 71.1% (p = 0.021), 89.4% and 81.9% (p = 0.022), and 93.5% and 94.6% (p = 0.699) 1 day, 6 months, and 1 year after surgery in Groups A and B, respectively. CONCLUSIONS Although intraoperative EMG monitoring during MVD was beneficial for identifying the offending vessel and suggesting the most appropriate surgical end point, loss of LSR did not always correlate with long-term HFS treatment outcome. Because the HFS cure rate improved over time, revision might be considered for persistent LSR when follow-up has been performed for more than 1 year and the spasm remains despite adequate decompression.

scholarly journals A Study to Find out Effect of Circuit Training on Balance in Stroke Patients- An Experimental Study

2021 ◽  
Vol 11 (7) ◽  
pp. 339-344
Author(s):  
Dafda Renuka H ◽  
Patel Prital P ◽  
Sheikh Safa A
Keyword(s):  
Experimental Study ◽  
Cognitive Skills ◽  
Sampling Method ◽  
Outcome Measure ◽  
Berg Balance Scale ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Circuit Training ◽  
Group A ◽  
Group B

Following stroke, patients lose functions of the motor, sensory and higher cognitive skills to various degrees which diminish their ability to balance effectively and make necessary postural adjustments. Circuit training was being used to improve balance in patients. Circuit training is a form of body conditioning that involves endurance training, resistance training, high intensity aerobic exercise and exercises performed in a circuit. Berg Balance Scale was used as an outcome measure. Method: It is an experimental study done in 20 stroke patients selected with the help of purposive sampling method. Patients were selected on the basis of inclusion criteria and were divided into two groups. Group A received circuit training and Group B received conventional training. Training was given for 3 session per week for 4 weeks. Pre and Post BBS was taken. Result: The study suggested that circuit training is more effective than conventional training in stroke patients. Conclusions: The study shows that there is effect of circuit training on balance in stroke patient Key words: Stroke, Balance, Circuit training, BBS, Conventional training.

scholarly journals Is Surrogate LH Surge Essential in All Induced Cycles?

2013 ◽  
Vol 26 (2) ◽  
pp. 72-76
Author(s):  
Mosammat Rashida Begum ◽  
Mariya Ehsan ◽  
Mosammat Shahina Begum ◽  
Farzana Khan ◽  
Maruf Siddiqi ◽  
...  
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Outcome Measure ◽  
Follicular Development ◽  
Target Population ◽  
Treated Group ◽  
Hormone Production ◽  
Main Outcome Measure ◽  
Group A ◽  
Group B ◽  
Ovarian Syndrome

Objective: Aim of this study was to identify the necessity of use of exogenous or surrogate  LH for triggering of ovulation in induced cycles. Materials and methods: This study was conducted in Infertility Care and Research Center (ICRC) Dhaka, Bangladesh. Three hundred anovulatory patients with polycystic ovarian syndrome (PCOS) were the target population for this study. The patients were treated by  different ovulation inducing agents to produce mature follicles. When follicle got the size of 18 mm or more LH was given to 150 patients (Group A) and 150 patients did not receive LH (Group B). Follicular rupture was monitored by USG. Main outcome measure was rupture of the follicle.Result: In group A 33.33% and in group B 34.67% patients responded by letrozole only, whereas 66.66% in group A and 65.34% in group B needed additional drugs like metformin glucocorticoids and gonadotropins. In both the groups response was similar in terms of number of follicular recruitment, follicular maturity, endometrial development and hormone production. Follicular rupture rate was similar in both hCG and non-hCG treated group. LUFS was detected only in 2.67% in group A and 2% cases in group B.Conclusion: If follicular development is adequate exogenous LH is not necessary for triggering of ovulation in all stimulated cycles. DOI: http://dx.doi.org/10.3329/bjog.v26i2.13783 Bangladesh J Obstet Gynaecol, 2011; Vol. 26(2) : 72-76  

scholarly journals Evaluation of efficacy and safety of doxofylline 800mg sustained release tablet in treatment of patients with COPD: an open label, prospective and RCT

2018 ◽  
Vol 7 (4) ◽  
pp. 644
Author(s):  
Prakash Narayan Khandelwal ◽  
Syed H. Maaz ◽  
Dhammraj M. Borade
Keyword(s):  
Quality Of Life ◽  
Sustained Release ◽  
Outcome Measure ◽  
Health Related Quality ◽  
Sustained Release Tablet ◽  
Related Quality ◽  
Health Related ◽  
Group A ◽  
Group B

Background: COPD is a major cause of health care burden worldwide and leading cause of death that is increasing in prevalence. Methylxanthines are used in the treatment of patients with asthma and COPD. Doxofylline (methylxanthine) shows improved disease control, reduced total daily dose of inhaled b2 agonists and improved patient compliance.Methods: This was a prospective, open labelled, randomized, two-arm, parallel group, controlled, clinical trial. 115 patients were randomized to two groups. Patients in group A received tablet doxofylline 400mg BD whereas patients in group B received tablet doxofylline 800mg SR for 4 weeks. Primary outcome measure of trial was change in FEV1 and secondary outcome measure were change in FVC/FEV1, change in symptoms score, effect on health-related quality of life (HRQOL) and safety of study medication.Results: At 4 week the FEV1increase by 13.028% and 17.647% in group A and B respectively. In group A FEV1/FVC increase by 5.79% and in group B it increases by 9.57% at 4 weeks. The symptom score of cough decrease by 77.35% and 97.43% in group A and group B respectively at 4 weeks. In group A shortness of breath decrease by 77.60% and in group B it decreases by 95.90% at 4 weeks. Tightness in chest decrease by 86.29% and 98.40% in group A and group B respectively at 4 weeks.Conclusions:Doxofylline 800mg sustained release tablet provided significantly greater improvement in FEV1, symptomatic control and health related quality of life compared to doxofylline 400mg. 

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