Refractory Ascites: Treatment and Complications Utilizing Peritoneovenous (Denver) Shunt

2017 ◽  
Vol 01 (04) ◽  
pp. 259-264
Author(s):  
Parvaneh Shadkam-Farrokhi ◽  
Edward Lee
Keyword(s):  
Symptomatic Relief ◽  
Treatment Method ◽  
Treatment Modalities ◽  
Refractory Ascites ◽  
Medical Providers ◽  
Standard Medical Therapy ◽  
Portosystemic Shunts ◽  
Surgical Methods ◽  
Peritoneovenous Shunts

AbstractIntractable ascites has long been an antagonizing problem for patients and medical providers. It is debilitating and frequently cannot be prevented by standard medical therapy. Ascites is primarily managed with salt restrictions, diuretics, and repeated paracentesis for symptomatic relief. However, 10% of patients become refractory to this first line of treatment. Several surgical methods such as the insertion of peritoneovenous shunts and transjugular intrahepatic portosystemic shunts have become popularized treatment modalities for the control of refractory ascites. Nevertheless, controversy resides over what is the best treatment method for the improvement in patients' quality of life and survival rate. We herein explore the different medical and surgical methods available for the control of refractory ascites with a focus on the advantages and complications associated with the usage of Denver peritoneovenous shunts.

scholarly journals Hemorrhoids and quality of life: “… two things incompatible”?

2021 ◽  
pp. 74-79
Author(s):  
M. V. Abritsova ◽  
A. M. Bogomazov ◽  
E. B. Golovko ◽  
E. A. Zagriadskii
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Social Life ◽  
Well Being ◽  
Treatment Method ◽  
Social Adaptation ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Surgical Methods

Hemorrhoids is one of the most common diseases in human. According to the latest data for 2017, the prevalence rates of hemorrhoids per 100 000 population in Russia are 410,3 in adults, 26.7 in children aged 15 to 17 years and 4,0 in children under 14 years old. Quality of life (QoL) is an important non-specific subjective parameter of well-being, representing an integrative characteristic of the physical, psychological, social and emotional status of the patient. Despite the high prevalence of hemorrhoids and the variety of modern methods of surgical treatment, there are very few studies addressing the QoL in this category of patients. There are significant differences between the patient and the Coloproctologist in the perception of HD, which, possibly, can lead to the hypertrophy of indications for surgical treatment. Understanding the effect of HD on social life and the concept of the well-being of a particular patient can help the doctor choose between conservative and surgical approaches in the treatment of hemorrhoids. On the other hand, due to the excessive shyness and mentality in our country, patients with HD tend to adapt to their disease, which leads to later seeking medical help and suboptimal efficacy of conservative therapy and minimally invasive surgical methods.This review presents the first Russian multicenter observational program EQUALISER (impact of different trEatment modalities on QUAlity of life of the patientS with acute and chronic hEmorRhoid disease) aimed at assessing the QoL of patients with HD, as well as the effect of the treatment method and types of surgical treatment on the social adaptation of the population.

scholarly journals Symptomatic Fluid Drainage: Peritoneovenous Shunt Placement

2017 ◽  
Vol 34 (04) ◽  
pp. 343-348
Author(s):  
George Getrajdman ◽  
Hooman Yarmohammadi
Keyword(s):  
Quality Of Life ◽  
Negative Impact ◽  
Symptomatic Relief ◽  
Malignant Ascites ◽  
Indwelling Catheters ◽  
Shunt Placement ◽  
Peritoneovenous Shunt ◽  
Peritoneovenous Shunts ◽  
Denver Shunt

AbstractAscites causes significant discomfort and has negative impact on patient's quality of life. Medical therapies including dietary restriction and diuretics are successful in only 40 to 44% of patients with malignant ascites and repeated paracentesis only provides temporary symptomatic relief. Therefore, a more permanent solution is necessary. Indwelling catheters or peritoneovenous shunt placement can provide more permanent symptomatic relief and improve patients' quality of life. Unlike indwelling catheters, peritoneovenous shunts do not limit patients' life style and therefore should be offered as first option in patients who are good candidates. Denver shunt (CareFusion-BD Worldwide) is the current available peritoneovenous shunt. In this article, the indications, contraindications, technical aspects of shunt placement, and techniques to prevent postprocedure complications will be discussed.

Ayurvedic Management of Interstitial Lung Disease : A Case Report

The Healer ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 126-131
Author(s):  
Dr.Minal Shashikumar Vaidya ◽  
Vd.Ashwin Prakash Shinde ◽  
Vd. Mugdha Aveenash Vaidya
Keyword(s):  
Symptomatic Relief ◽  
Cost Effective ◽  
Blood Stream ◽  
Forced Expiratory Volume ◽  
Interstitial Lung Diseases ◽  
Treatment Modalities ◽  
Permanent Cure ◽  
Substantial Morbidity

Interstitial Lung Diseases(ILD) are a group of diffuse parenchymal lung disorders, most of which cause progressive scarring of lung tissue associated with substantial morbidity and mortality as the scarring in ILD eventually affects the ability to breathe and get enough oxygen into the blood- stream. Prolonged ILD may result in pulmonary fibrosis. As there is no definite treatment for the disease, it has remained a great problem for the patients. Several conventional treatment modalities are in existence but not much comprehensive. Though the permanent cure for the disease is not available but Ayurveda can provide cost-effective and conveniently the better treatment which relieves the symptoms to a good extent and improves the quality of life of the diseased. In this article, a case study presented on a case of ILD. A 63 years old female, diagnosed case of ILD, attended Kayachikita OPD , with chief complaint of breathlessness since 2018 but severe from 1 month. Patient got admitted in IPD and treated on the Ayurvedic principles. At the time of discharge, symptomatic relief was found in breathlessness, effectiveness in FEV1( Forced Expiratory Volume in 1 sec)and also maitained saturation , but no significant changes in X-Ray Chest was observed after treatment.

Management of Symptomatic Ascites in Hospice Patients With Paracentesis

2011 ◽  
Vol 29 (5) ◽  
pp. 405-408 ◽  
Author(s):  
Ivan N. Zama ◽  
Millicent Edgar
Keyword(s):  
Simple Procedure ◽  
Symptomatic Relief ◽  
Cost Effective ◽  
Refractory Ascites ◽  
Standard Precautions ◽  
Risk Of Bleeding ◽  
Home Based ◽  
International Normalization Ratio ◽  
Hospice Patients

Refractory ascites causes significant distress to patients and can be managed in various ways. In hospice patients where the goal of care is to preserve comfort and foster better quality of life, diuretics should be tried first; however, in resistant cases, home-based paracentesis should be entertained. Home-based paracentesis is a safe and simple procedure that can be done blindly, if done under standard precautions there is minimal associated risk of bleeding, infection or perforation and no need for pre or post-laboratory testing or the correction of high international normalization ratio or thrombocytopenia. Home-based paracentesis is cost effective, provides immediate symptomatic relief, good patient and caregiver satisfaction and obviates the associated distress to the patient and family of transporting the patient for either outpatient or inpatient paracentesis.

scholarly journals Management of Scars in Skin of Color

2020 ◽  
pp. 371-377
Author(s):  
Huidi Tchero
Keyword(s):  
Randomized Clinical Trials ◽  
Surgical Excision ◽  
Treatment Method ◽  
Treatment Modalities ◽  
Hypertrophic Scars ◽  
Strategic Assessment ◽  
Wound Healing Response ◽  
Intralesional Steroid ◽  
Silicone Gel Sheet

AbstractKeloids and hypertrophic scars are abnormal scars, produced by an odd wound-healing response to trauma with a higher incidence in pigmented skin patients. They could be painful or itchy, producing functional and/or cosmetic disability. This chapter focuses on defining scars especially in pigmented skin and the different methods for treating keloids that have been investigated in the literature. Up to the present time, the ideal treatment method has not been defined, although numerous modalities have been designated. We will represent the variances among different scar types and their management methods, concentrating on their indications, modes of action, uses, safety, and efficiency of the following therapies: intralesional steroid, injections of silicone gel/sheet, radiotherapy, photodynamic therapy, electrical stimulation, surgical excision and adjuvant therapy, and cryosurgery. Combination therapies have also shown some value. Still, there is a shortage of randomized clinical trials (RCTs) evaluating such treatment modalities. Management of scar in pigmented (colored) skin is clinically challenging. Therefore, strategic assessment and targeted therapy with focus on deterring recurrence are most needed. The quality of evidence is crucial to select efficient treatments for patients with colored skin, presenting with keloid.

Gad-Awful Spasms

2018 ◽  
pp. 103-108
Author(s):  
Aaron E. Miller ◽  
Tracy M. DeAngelis ◽  
Michelle Fabian ◽  
Ilana Katz Sand
Keyword(s):  
Neurological Disease ◽  
Behavioral Therapy ◽  
Symptomatic Relief ◽  
Treatment Modalities ◽  
Acid Decarboxylase ◽  
Muscle Rigidity ◽  
Axial Muscles ◽  
Gad 65 ◽  
Gad 65 Antibodies

Stiff person syndrome (SPS) is a rare autoimmune neurological disease that causes progressive, fluctuating, painful muscle rigidity and spasms, generally beginning in the axial muscles, truncal region, and progressing to proximal musculature. A hyperlordotic posture is considered an early clinical hallmark of the condition. The most common pathological correlate is with anti-glutamic acid decarboxylase (GAD) 65 antibodies, but several other associated antibodies have been identified There is a clinical spectrum of disease with variants including stiff leg syndrome, progressive encephalomyelitis with rigidity and myoclonus (PERM), and a paraneoplastic variant, often associated with anti-amphiphysin antibodies. Electromyographic findings reveal continuous motor activity. Treatment modalities for SPS focus primarily on symptomatic relief to improve quality of life. Gamma amino butyric acid (GABA)ergic agonists, including benzodiazepines, such as diazepam and baclofen, are first-line therapies for muscle rigidity and spasms. Immunotherapies such as corticosteroids, intravenous immunoglobulin (IVIg), plasmapheresis, and rituximab have demonstrated benefit, As symptoms can be provoked by anxiety and emotional stressors, psychological support with cognitive behavioral therapy should be considered.

The first experience of bipolar transurethral operations in surgery of benign prostatic hyperplasia

2018 ◽  
pp. 10-20
Author(s):  
Н.А. Глотов ◽  
Н.Е. Соколов ◽  
Ю.Б. Смоляков
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostatic Hyperplasia ◽  
Medium Term ◽  
Significance Level ◽  
The Road ◽  
Surgical Methods ◽  
The Comparative Study ◽  
Endoscopic Methods ◽  
Qualitative Characteristics

Представлены результаты внедрения в хирургическую практику урологического отделения Дорожной клинической больницы г. Ярославль биполярной техники трансуретральной резекции (БТУР) и энуклеации простаты (ТУЭБ) для лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) средних и больших размеров. В сравнительное исследование включено 164 пациента, разделенных по методам операции на 2 основные группы (ТУЭБ - 33 человека, БТУР - 49) и 2 контрольные (открытая простатэктомия - ОПЭ - 38 и монополярная ТУР - 44). Для новых эндоскопических методов установлено значимое снижение объема кровопотери, частоты геморрагических осложнений, сроков послеоперационной катетеризации и госпитализации. Для количественной оценки различий средних и относительных показателей использо-вали непараметрический критерий Манна-Уитни, оценка качественных признаков проводилась с применением критерия Пирсона (χ2), уровень значимости различий для исследования выбран р ≤ 0,05. Анализ послеоперационной динамики клинических показателей в среднесрочной перспективе показал сходную радикальность и эффектив-ность сравниваемых методов. Установленные меньшая инвазивность, большая безопасность и лучшая переносимость биполярных эндоскопических операций демонстрируют перспективность их внедрения взамен бывших стандартных хирургических методов, что позволит повысить качество оперативного лечения и сократить затраты стационара. The results of the introduction into surgical practice of the urological Department of the road clinical hospital of Yaroslavl bipolar technique of transurethral resection (BTTR) and enucleation of the prostate (EOTP) for the treatment of benign prostatic hyperplasia (BPH) of medium and large sizes are presented. The comparative study included 164 patients, divided by the methods of surgery into 2 main groups (EOTP - 33 people, BTTR - 49) and 2 control (open prostatectomy - OPE - 38 and monopolar TTR - 44). For new endoscopic methods, a significant reduction in the volume of blood loss, the frequency of hemorrhagic complications, the timing of postoperative catheterization and hospitalization was established. Nonparametric Mann-Whitney test was used to quantify the differences in mean and relative indicators, qualitative characteristics were evaluated using Pearson test (χ2), the significance level of the differences for the study was chosen p ≤ 0.05. Analysis of postoperative dynamics of clinical parameters in the medium term showed similar radicality and effectiveness of the compared methods. The lower invasiveness, greater safety and better tolerability of bipolar endoscopic operations demonstrate the prospects of their implementation instead of the former standard surgical methods, which will improve the quality of surgical treatment and reduce the costs of the hospital.

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