Quadrangular Fixation of Pectus Bars to Prevent Displacement in Nuss Procedure

Background Double pectus bars are sometimes inserted to correct pectus excavatum. Method of double-bar fixation to prevent bar displacement has been rarely reported. We have used quadrangular fixation of the double pectus bars. The objective of this study was to compare results of the quadrangular fixation procedure with those of the classic separate fixation procedure. Methods From September 2011 to January 2016, 86 patients underwent Nuss procedure with double-bar insertion. In 44 patients, each bar was fixed separately (group A). In 42 patients, quadrangular fixation of the bars was performed with metal plates (group B). Patient demographics, Haller index (HI), bar displacement index (BDI), and reoperation rate were compared between the two groups. Results The mean patient age was 17.2 years (range: 3–40 years) in group A and 17.8 years (range: 4–30 years) in group B. There was no significant difference in preoperative or postoperative HIs between the two groups (all p >0.05). Early complication rates were 15.9% in group A and 9.5% in group B (p > 0.05). In group A, three patients underwent surgery to correct bar displacement (6.8% of reoperation rate), whereas there was no corrective surgery in group B. BDIs of the two groups were significantly different (p < 0.01). Conclusions When quadrangular fixation was performed with upper and lower pectus bars bilaterally fixed by connecting each bar with plates, bar displacement was prevented more effectively than separate fixation, thus minimizing reoperation.

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CO2 or air cholangiography reduces the risk of post-ERCP cholangitis in patients with Bismuth type IV hilar biliary obstruction

10.21203/rs.2.22553/v2 ◽

2020 ◽

Author(s):

wenhui zhang ◽

Peng peng Ding ◽

lei liu ◽

yanling wang ◽

wenhui lai ◽

...

Keyword(s):

Liver Function Tests ◽

Complication Rates ◽

Endoscopic Retrograde ◽

Type Iv ◽

Significant Difference ◽

Group A ◽

Hilar Biliary Obstruction ◽

The Mean ◽

Malignant Hilar Obstruction ◽

Group B

Abstract Background: Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. This study aims to compare the incidence of cholangitis associated with the use of contrast agent, air and CO2 for cholangiography in type IV hilar biliary lesions. Methods: The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, was retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast (n=22); group B, air (n=18); group C, CO2 (n=30). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention. Results: At baseline, there was no significant difference in the patient’s age, gender, symptoms and liver function tests among the three groups (P>0.05). The complication rates was significantly higher in group A than in groups B and C (63.6% vs. 26.7% and 27.8%, P<0.05). The incidence of post-ERCP cholangitis was significantly higher in group A (P<0.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A (P<0.05). There was no significant difference in the 30-day mortality rate among the three groups (P>0.05). Furthermore, there was no significant difference between group B and C in terms of primary end points. Conclusion: CO2 or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.

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CO2 or air cholangiography reduces the risk of post-ERCP cholangitis in patients with Bismuth type IV hilar biliary obstruction

10.21203/rs.2.22553/v3 ◽

2020 ◽

Author(s):

wenhui zhang ◽

Peng peng Ding ◽

lei liu ◽

yanling wang ◽

wenhui lai ◽

...

Keyword(s):

Liver Function Tests ◽

Complication Rates ◽

Endoscopic Retrograde ◽

Type Iv ◽

Significant Difference ◽

Group A ◽

Hilar Biliary Obstruction ◽

The Mean ◽

Malignant Hilar Obstruction ◽

Group B

Abstract Background: Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. The present study aims to compare the incidence of cholangitis associated with the use of a contrast agent, air and CO2 for cholangiography in type IV hilar biliary lesions. Methods: The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, were retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast (n=22); group B, air (n=18); group C, CO2 (n=30). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention. Results: At baseline, there was no significant difference in terms of the patient’s age, gender, symptoms and liver function tests among the three groups (P>0.05). The complication rates were significantly higher in group A than in groups B and C (63.6% vs. 26.7% and 27.8%, P<0.05). The incidence of post-ERCP cholangitis was significantly higher in group A (P<0.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After the ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A (P<0.05). However, there was no significant difference in the 30-day mortality rate among the three groups (P>0.05). Furthermore, there was no significant difference between groups B and C in terms of primary end points. Conclusion: CO2 or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.

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CO2 or air cholangiography reduces the risk of post-ERCP cholangitis in patients with Bismuth type IV hilar biliary obstruction

10.21203/rs.2.22553/v4 ◽

2020 ◽

Author(s):

wenhui zhang ◽

Peng peng Ding ◽

lei liu ◽

yanling wang ◽

wenhui lai ◽

...

Keyword(s):

Liver Function Tests ◽

Complication Rates ◽

Endoscopic Retrograde ◽

Type Iv ◽

Significant Difference ◽

Group A ◽

Hilar Biliary Obstruction ◽

The Mean ◽

Malignant Hilar Obstruction ◽

Group B

Abstract Background: Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. The present study aims to compare the incidence of cholangitis associated with the use of a contrast agent, air and CO2 for cholangiography in type IV hilar biliary lesions. Methods: The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, were retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast (n=22); group B, air (n=18); group C, CO2 (n=30). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention. Results: At baseline, there was no significant difference in terms of the patient’s age, gender, symptoms and liver function tests among the three groups (P>0.05). The complication rates were significantly higher in group A than in groups B and C (63.6% vs. 26.7% and 27.8%, P<0.05). The incidence of post-ERCP cholangitis was significantly higher in group A (P<0.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After the ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A (P<0.05). However, there was no significant difference in the 30-day mortality rate among the three groups (P>0.05). Furthermore, there was no significant difference between groups B and C in terms of primary end points. Conclusion: CO2 or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.

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CO2 Cholangiography Reduce Cholangitis Risk in Patients with Bismuth Type IV Hilar Biliary Obstruction during ERCP

10.21203/rs.2.22553/v1 ◽

2020 ◽

Author(s):

wenhui zhang ◽

Peng peng Ding ◽

lei liu ◽

yanling wang ◽

wenhui lai ◽

...

Keyword(s):

Liver Function Tests ◽

Complication Rates ◽

Type Iv ◽

Endoscopic Palliation ◽

Significant Difference ◽

Group A ◽

Hilar Biliary Obstruction ◽

The Mean ◽

The Difference ◽

Group B

Abstract Backgrounds: Endoscopic palliation in hilar obstruction requires endoscopic retrograde cholangiopancreatography (ERCP), whereas cholangitis could be induced by contrast injection. Post ERCP cholangitis risk is particularly high in Bismuth type IV hilar obstruction, and the risk is further increased if the contrast could not be drained. The aim of this study is to evaluate the cholangitis risks associated with contrast agent, air and CO 2 injection in type IV hilar lesions. Methods : The authors retrospectively evaluated the utility of contrast, air and CO 2 cholangiography in consecutive 70 patients with type IV hilar obstruction. The patients were divided into 3 groups based on the agent used: A) contrast (n=22), B) air (n=18), and C) CO 2 (n=30). Prior to ERCP, MRCP was obtained in all patients to guide endoscopic intervention. Results : At baseline, there was no significant difference in patient’s age, gender, symptoms, liver function tests between different groups ( p ＞0.05). The complication rates in group B and C were significantly lower than that in group A (27.8% and 26.7% versus 63.6%, p ＜0.05). Except cholangitis risk ( p ＜0.05), no significant difference was found in post ERCP pancreatitis and bleeding risks (both p ＞0.05) between the 3 groups. After ERCP, the mean hospital stay duration was shorter in group B and C compared with group A ( p ＜0.05). However, the difference of one month mortality between 3 groups was not significant ( p ＞0.05). There was no significant difference between group B and C in primary end points. Conclusions : CO 2 cholangiography based ERCP is safer and should be utilized to reduce the risk of post-ERCP cholangitis in typer IV hilar obstruction.

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Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000231 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Hwa Jun Kang ◽

Hong-Geun Jung ◽

Jong-Soo Lee ◽

Sungwook Kim ◽

Mao Yuan Sun

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Fixation Method ◽

Kirschner Wires ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

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Surgical treatment of multiple brain metastases

Journal of Neurosurgery ◽

10.3171/jns.1993.79.2.0210 ◽

1993 ◽

Vol 79 (2) ◽

pp. 210-216 ◽

Cited By ~ 354

Author(s):

Rajesh K. Bindal ◽

Raymond Sawaya ◽

Milam E. Leavens ◽

J. Jack Lee

Keyword(s):

Brain Metastases ◽

Survival Time ◽

Prognostic Indicators ◽

Survival Duration ◽

Surgical Removal ◽

Complication Rates ◽

Multiple Brain Metastases ◽

Significant Difference ◽

Group A ◽

Group B

✓ The authors conducted a retrospective review of the charts of 56 patients who underwent resection for multiple brain metastases. Of these, 30 had one or more lesions left unresected (Group A) and 26 underwent resection of all lesions (Group B). Twenty-six other patients with a single metastasis who underwent resection (Group C) were selected to match Group B by type of primary tumor, time from first diagnosis of cancer to diagnosis of brain metastases, and presence or absence of systemic cancer at the time of surgery. Statistical analysis indicated that Groups A and B were also homogeneous for these prognostic indicators. Median survival duration was 6 months for Group A, 14 months for Group B, and 14 months for Group C. There was a statistically significant difference in survival time between Groups A and B (p = 0.003) and Groups A and C (p = 0.012) but not between Groups B and C (p > 0.5). Brain metastasis recurred in 31% of patients in Group B and in 35% of those in Group C; this difference was not significant (p > 0.5). Symptoms improved after surgery in 65% of patients in Group A, 83% in Group B, and 84% in Group C. Symptoms worsened in 13% of patients in Group A, 6% in Group B, and 0% in Group C. Groups A, B, and C had complication rates per craniotomy of 8%, 9%, and 8%, and 30-day mortality rates of 3%, 4%, and 0%, respectively. Guidelines for management of patients with multiple brain metastases are discussed. The authors conclude that surgical removal of all lesions in selected patients with multiple brain metastases results in significantly increased survival time and gives a prognosis similar to that of patients undergoing surgery for a single metastasis.

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The role of tolvaptan in prevention of hyponatremia in patients undergoing transurethral resection of prostate surgery- A randomized double blind study

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.059 ◽

2021 ◽

Vol 8 (2) ◽

pp. 321-325

Author(s):

Dinesh Kumar Singh ◽

B B Baj ◽

Vipin Goyal

Keyword(s):

Transurethral Resection ◽

Blind Study ◽

Transurethral Resection Of Prostate ◽

Double Blind Study ◽

Double Blind ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B

The aim of our study to determine the role of tolvaptan in prevention of hyponatremia in transurethral resection of prostate surgery. This is randomized double-blind study conducted in 60 ASA grade status 1 and 2 patients age group between 45-80 yrs undergoing TURP under spinal anaesthesia in urology operation theatre in Mahatma Gandhi hospital Jaipur after receiving permission from hospital ethical committee. A detailed history, complete physical examination and routine investigation were done for all patients followed by informed written consent was obtained. Patients are randomly divided into 2 groups. In group A -30 patients who received orally tab tolvaptan 15 mg and group B-30 patients who received orally tab multivitamin 2 hrs before surgery after doing electrolytes of the patients in the morning. In both groups age (in yrs), wt (in kg), ASA grade, volume of irrigating fluid (in litres), volume of prostate resected (in gm) and duration of surgery (in minutes) all demographic and surgical details data were compared. Electrolytes were compared in both groups pre and post-operatively and statistical analysis was done.There was significant difference in post-operative sodium level between the two groups (A and B). The mean level of sodium significantly reduced post-operatively in group –B (control grp). The mean level of sodium significantly increased post-operatively in group –A (tolvaptan grp). We conclude single dose of tolvaptan -15 mg found to effective in prevention of hyponatremia in patients undergoing TURP.

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Clinical Results Of A Lamina With Spinous Process And An Iliac Graft As Bone Grafts In The Surgical Treatment Of Single-Segment Lumbar Pyogenic Discitis: A Retrospective Cohort Study

10.21203/rs.3.rs-49502/v1 ◽

2020 ◽

Author(s):

Weiyang Zhong ◽

Xinjie Liang ◽

Xiaolin Wang ◽

Ke Tang ◽

Tianji Huang ◽

...

Keyword(s):

Hospital Stay ◽

Spinous Process ◽

Bone Grafts ◽

Clinical Results ◽

Single Segment ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Segmental Angle

Abstract Background: A retrospective study investigated and compared the results of a lamina withspinous process (LSP) and an iliac graft (IG) as bone grafts in single-segment lumbar pyogenic discitis (LPD) through one-stage-posterior-only approach with radical debridement and internal instrumentation.Methods: Data from 37 patients were reviewed. A LSP was placed in 17 patients (group A), and an IG was implemented in 20 patients (group B). The surgery time, surgery hemorrhage, hospital stay, drainage, and follow-up (FU) were reviewed. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, segmental angle, intervertebral height and bony fusion time were compared preoperatively and at the final FU.Results: All patients were followed-up for a mean of 27.94±2.35 months in group A and 30.29±1.89 months in group B, without a difference. The mean age was younger in group A than in group B (P<0.05). The surgery time, surgery hemorrhage, and hospitalization cost were lower in group A than in group B (P<0.05), except for the hospital stay and drainage time. Fever occurred in 10 patients in group A and 12 patients in group B. The ESR, CRP level, and VAS and ODI scores were significantly decreased, and there were no significant differences between the groups at the final FU. The distribution of bacterial agents in blood culture was 1 case of Aerobacter cloacae, 2 of Staphylococcus aureus, 2 of Escherichia coli, and 1 of Streptococcus viridis in group A and 1 of S. aureus，1 of Staphylococcus warneri and 2 of Klebsiella pneumoniae in group B. Pyogenic infection was observed in the pathological findings of all patients. No significant difference was found in the mean segmental angle or mean intervertebral height preoperation and at the final FU between the groups.Conclusion: The use of LSP as a new bone graft is reliable, safe, and effective for surgical management for the LPD while surgery is proposed as a good management strategy for LPD in carefully selected patients.

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PREVALENCE OF HEPATIC STEATOSIS AMONG CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS AND ITS ASSOCIATION WITH NUTRITIONAL STATUS

Revista Paulista de Pediatria ◽

10.1590/1984-0462/;2019;37;4;00007 ◽

2019 ◽

Vol 37 (4) ◽

pp. 435-441

Author(s):

Amanda Oliva Gobato ◽

Ana Carolina Junqueira Vasques ◽

Antonio Fernando Ribeiro ◽

Roberto Massao Yamada ◽

Gabriel Hessel

Keyword(s):

Cystic Fibrosis ◽

Nutritional Status ◽

Children And Adolescents ◽

Hepatic Steatosis ◽

Statistical Tests ◽

The Body ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B

ABSTRACT Objective: To determine the prevalence of hepatic steatosis (HS) in children and adolescents with cystic fibrosis (CF) and associate it with nutritional status. Methods: Cross-sectional study with children and adolescents with CF diagnosis. Weight and height were used to calculate the body mass index (BMI) and subsequent classification of the nutritional status. The midarm circumference (MAC), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were used to evaluate body composition. Abdominal ultrasonography was performed for diagnosis of HS. The statistical tests used were Student’s t test, Mann-Whitney test and chi-square test with significance level of 5%. Results: 50 patients with CF were evaluated, 18 (36%) were diagnosed with HS (Group A) and 32 (64%) without HS (Group B). The mean age of Group A was 13,2±4,9 years old and Group B 11,7±4,9; for BMI, the value for Group A was 18,0±4,1 and Group B was 15,7±3,8; the TSF of Group A was 8,4±3,5 mm and Group B was 7,0±2,5 mm. For these variables, there was no significant difference between the groups. The mean of MAC and MAMC differed significantly between the groups, being higher in the HS group, with p values of 0,047 and 0,043. Conclusions: The frequency of HS in patients with CF is high and it is not related to malnutrition, according to the parameters of BMI, TSF and MAMC. The values of MAC and MAMC indicated a greater reserve of muscle mass in patients with HS.

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Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i1.25413 ◽

2019 ◽

Vol 11 (1) ◽

pp. 24-28

Author(s):

Ben Limbu ◽

Hannah S Lyons ◽

Mohan Krishna Shrestha ◽

Geoffrey C Tabin ◽

Rohit Saiju

Keyword(s):

Success Rate ◽

Financial Burden ◽

Controlled Trial ◽

Nasolacrimal Duct ◽

Complication Rates ◽

Tube Removal ◽

Significant Difference ◽

Silicone Stent ◽

Group A ◽

Group B

Introduction: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. Methods: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. Results: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. Conclusion: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.

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