scholarly journals Potential Benefits of Laparoscopic Repair of Duodenal Atresia: Insights from a Retrospective Comparative Study

2019 ◽  
Vol 30 (01) ◽  
pp. 033-038
Author(s):  
Martin Sidler ◽  
Florin Djendov ◽  
Joe I. Curry ◽  
Simon Blackburn ◽  
Stefano Giuliani ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Laparoscopic Repair ◽  
Duodenal Atresia ◽  
Exact Test ◽  
Congenital Duodenal Obstruction ◽  
Postoperative Time ◽  
Potential Benefits ◽  
Group 5 ◽  
Retrospective Comparative Study ◽  
Open Versus

Abstract Introduction Congenital duodenal obstruction (CDO) repair can be performed open or laparoscopically. We aimed to determine the potential benefit of laparoscopic repair regarding tolerance of enteral feeding, postoperative pain, hospital stay, and complication rate. Materials and Methods In a single-center retrospective cohort study, we compared neonates with isolated CDO operated open versus laparoscopically from 2010 to 2019. No transanastomotic tubes were used, and anastomoses were created in a side-to-side fashion in all cases. An early feeding policy is applied for all cases operated at our institution. Statistical comparison was performed using the Mann–Whitney's test or Fisher's exact test where appropriate. Results Forty-one patients analyzed were similar regarding body weight, gestational age, and proportion of patients with trisomy 21. Median follow-up was 21 months. Four (20%) out of 20 laparoscopic procedures started laparoscopically were converted to open. Comparing the 21 open with the 16 laparoscopically completed patients, median anesthetic duration was shorter by 18% in the open versus laparoscopic completed group (218 vs. 179 minutes, respectively; p = 0.025). Median postoperative time to full enteral feeds was shorter by 4 days in the first group (7 vs. 11 days, respectively; p = 0.028). In accordance, the median duration of parenteral nutrition (PN) was less than half in the laparoscopic completed compared with the open group (5 vs. 11.5 days, respectively; p = 0.031). Postoperative opioids were required for only half the duration in the laparoscopically completed group compared with open (2 vs. 4 days, respectively; p = 0.026). Outcomes such as length of stay, the occurrence of strictures or adhesions requiring reintervention, or line sepsis were similar in both groups. Conclusion Patients undergoing laparoscopic CDO repair at our institution benefited from shorter time to full enteral feeds, and reduced the need for PN as well as postoperative pain medication.

scholarly journals Laparoscopic repair of congenital duodenal obstruction is feasible even in small-volume centres

2016 ◽  
Vol 98 (8) ◽  
pp. 578-580 ◽  
Author(s):  
BJ MacCormack ◽  
JPH Lam
Keyword(s):  
Laparoscopic Repair ◽  
Duodenal Obstruction ◽  
Small Volume ◽  
Duodenal Atresia ◽  
Associated Anomalies ◽  
Extensive Experience ◽  
Intracorporeal Suturing ◽  
Congenital Duodenal Obstruction ◽  
Age At Surgery ◽  
Sick Children

INTRODUCTION It has been suggested that laparoscopic repair of congenital duodenal obstruction (CDO) should be restricted to a limited number of designated centres of expertise. After gaining extensive experience with intracorporeal suturing in other procedures, we evaluated the feasibility of this approach at the Royal Hospital for Sick Children (RHFSC; Edinburgh, UK). METHODS We conducted a retrospective review of all cases of CDO presenting to the RHFSC from 2012 to 2014. Cases were identified from our electronic database using standardised codes. Data comprised: gestation; birth weight; associated anomalies; patient age and weight at surgery; operative time; complications; postoperative course. RESULTS Five consecutive non-selected cases of isolated CDO were repaired laparoscopically, and all were carried out by the senior surgeon. The male:female ratio was 4:1. Corrected gestational age at surgery was 35–38 weeks, and the weight at surgery was 1.7–3.1 kg. None of our patients had significant associated anomalies. CONCLUSIONS The present study demonstrates the feasibility of laparoscopic repair of CDO in small-volume centres, and is the first report of laparoscopically managed congenital duodenal atresia in twins.

PREEMPTIVE ANALGESIA WITH AMITRIPTYLINE IN WOMEN UNDERGOING ABDOMINAL HYSTERECTOMY: A RANDOMIZED CLINICAL TRIAL

2020 ◽  
pp. 2-5
Author(s):  
Antônio Henriques De França Neto ◽  
Alexandre Magno Nóbrega Marinho ◽  
Eveline Pereira De Arruda Agra ◽  
Priscilla Guimarães Alves ◽  
Josikwylkson Costa Brito ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Pressure Pain Threshold ◽  
Abdominal Hysterectomy ◽  
Tricyclic Antidepressant ◽  
Preemptive Analgesia ◽  
Chi Square ◽  
Double Blind ◽  
Exact Test ◽  
Student’S T

The concept of preemptive analgesia, albeit long-standing, has reemerged. Consequently, recent research has focused on testing a variety of drugs preoperatively to prevent the occurrence of postoperative pain, a major factor of morbidity. Amitriptyline is a tricyclic antidepressant used to treat chronic pain. Because amitriptyline acts on pain transmission pathways, it could theoretically be used as an agent for the prevention of postoperative pain. This study evaluated the effectiveness of amitriptyline in preventing pain in patients submitted to hysterectomy, the most commonly performed gynecological surgery. A randomized, double-blind clinical trial was conducted with 145 patients, 72 of these receiving amitriptyline and 73 placebo. All patients were evaluated at 6, 12, 24 and 48 hours after surgery using a visual analog scale (VAS) for pain and algometry to determine the pressure-pain threshold. Statistical analysis was conducted using the chi-square test of association, Student's t-test, and the Mann-Whitney test, with Fisher's exact test being used whenever appropriate. No statistically signicant difference was found between the two groups with respect to pain at any of the time points evaluated, leading to the conclusion that at a dose of 25 mg, amitriptyline is ineffective in preventing postoperative pain in patients submitted to abdominal hysterectomy

Open versus laparoscopic repair of traumatic diaphragmatic injury: A nationwide propensity-matched analysis

2021 ◽  
Vol 268 ◽  
pp. 452-458
Author(s):  
Omar Obaid ◽  
Ahmad Hammad ◽  
Letitia Bible ◽  
Michael Ditillo ◽  
Lourdes Castanon ◽  
...  
Keyword(s):  
Laparoscopic Repair ◽  
Diaphragmatic Injury ◽  
Open Versus

CONGENITAL ATRESIA AND STENOSIS OF THE DUODENUM

PEDIATRICS ◽  
1969 ◽  
Vol 43 (1) ◽  
pp. 79-83
Author(s):  
Eric W. Fonkalsrud ◽  
Alfred A. deLorimier ◽  
Daniel M. Hays
Keyword(s):  
Congenital Malformations ◽  
Duodenal Obstruction ◽  
Duodenal Atresia ◽  
Operative Techniques ◽  
Congenital Atresia ◽  
Late Mortality ◽  
Congenital Duodenal Obstruction ◽  
American Academy Of Pediatrics ◽  
Associated Malformations ◽  
Major Congenital Malformations

A review is presented of 503 patients with congenital duodenal obstruction, compiled from 65 hospitals by the Surgical Section of the American Academy of Pediatrics. Four hundred eighty-seven patients underwent primary operative correction of the malformation with an overall early and late mortality rate of 36%. Complications from associated major congenital malformations were the leading cause of death. Many of these anomalies were potentially correctable had they been recognized and early treatment instituted. More than half of the infants with duodenal atresia had associated malformations. Thirty percent of the patients had Down's syndrome. End-to-side or side-to-side duodenoduodenostomy or jejunostomy are the most commonly used operative techniques for duodenal atresia. General anesthesia and tube gastrostomy are usually employed.

Randomised clinical trial comparing the perioperative analgesic efficacy of oral tramadol and intramuscular tramadol in cats

2021 ◽  
pp. 1098612X2110404
Author(s):  
Sébastien H Bauquier
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Analgesic Efficacy ◽  
Randomised Clinical Trial ◽  
Rescue Analgesia ◽  
Exact Test ◽  
Pain Scores ◽  
Significant Difference ◽  
American Society ◽  
Induction Of Anaesthesia

Objectives The aim of this study was to evaluate the analgesic efficacy of oral tramadol in cats undergoing ovariohysterectomy. Methods Twenty-four female domestic cats, American Society of Anesthesiologists class I, aged 4–24 months, were included in this positive controlled, randomised, blinded clinical trial. Cats admitted for ovariohysterectomy were allocated to group oral tramadol (GOT, n = 12) or group intramuscular tramadol (GIMT, n = 12). In GOT, tramadol (6 mg/kg) was given orally 60 mins, and saline was given intramuscularly 30 mins, before induction of anaesthesia. In GIMT, granulated sugar in capsules was given orally 60 mins and tramadol (4 mg/kg) intramuscularly 30 mins before induction of anaesthesia. In both groups, dexmedetomidine (0.007 mg/kg) was given intramuscularly 30 mins before induction of anaesthesia with intravenous propofol. Anaesthesia was maintained with isoflurane in oxygen, and atipamezole (0.037 mg/kg) was given intramuscularly 10 mins after extubation. The UNESP-Botucatu multidimensional composite scale was used to conduct pain assessments before premedication and at 20, 60, 120, 240 and 360 mins post-extubation or until rescue analgesia was given. To compare groups, the 60 min postoperative pain scores and the highest postoperative pain scores were analysed via a two-tailed Mann–Whitney test, and the incidences of rescue analgesia were analysed via a Fisher’s exact test; P <0.05. Results There was no significant difference between groups for the 60 min ( P = 0.68) pain scores. The highest postoperative pain score was higher for GIMT compared with GOT ( P = 0.04). Only two cats required rescue analgesia, both from GIMT. The incidence of rescue analgesia was not significantly different between groups ( P = 0.46). Conclusions and relevance In the present study, preoperative administration of oral tramadol at 6 mg/kg to cats provided adequate analgesia for 6 h following ovariohysterectomy surgery.

Pain associated with cemented and uncemented long-stemmed tibial components in revision total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 165-170
Author(s):  
Darin J. Larson ◽  
John H. Rosenberg ◽  
Maxwell A. Lawlor ◽  
Kevin L. Garvin ◽  
Curtis W. Hartman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Stem Length ◽  
Exact Test ◽  
Patient Dissatisfaction ◽  
Total Knee ◽  
Revision Tka

Aims Stemmed tibial components are frequently used in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate patient satisfaction, overall pain, and diaphyseal tibial pain in patients who underwent revision TKA with cemented or uncemented stemmed tibial components. Methods This is a retrospective cohort study involving 110 patients with revision TKA with cemented versus uncemented stemmed tibial components. Patients who underwent revision TKA with stemmed tibial components over a 15-year period at a single institution with at least two-year follow-up were assessed. Pain was evaluated through postal surveys. There were 63 patients with cemented tibial stems and 47 with uncemented stems. Radiographs and Knee Society Scores were used to evaluate for objective findings associated with pain or patient dissatisfaction. Postal surveys were analyzed using Fisher’s exact test and the independent-samples t-test. Logistic regression was used to adjust for age, sex, and preoperative bone loss. Results No statistically significant differences in stem length, operative side, or indications for revision were found between the two cohorts. Tibial pain at the end of the stem was present in 25.3% (16/63) of cemented stems and 25.5% (12/47) of uncemented stems (p = 1.000); 74.6% (47/63) of cemented patients and 78.7% (37/47) of uncemented patients were satisfied following revision TKA (p = 0.657). Conclusion There were no differences in patient satisfaction, overall pain, and diaphyseal tibial pain in cemented and uncemented stemmed tibial components in revision TKA. Patient factors, rather than implant selection and surgical technique, likely play a large role in the presence of postoperative pain. Stemmed tibial components have been shown to be a possible source of pain in revision TKA. There is no difference in patient satisfaction or postoperative pain with cemented or uncemented stemmed tibial components in revision TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):165–170.

403 CONTROL OF OVULATION IN SOWS IN THE TROPICAL ENVIRONMENT USING HUMAN CHORIONIC GONADOTROPHIN IN COMPARISON WITH GONADOTROPIN-RELEASING HORMONE ANALOG

2010 ◽  
Vol 22 (1) ◽  
pp. 358
Author(s):  
K. Buranaamnuay ◽  
K. Wongkaweewit ◽  
R. Raksasub ◽  
P. Prommachart ◽  
P. Tummaruk ◽  
...  
Keyword(s):  
Hormonal Treatment ◽  
Control Group ◽  
Gnrh Analog ◽  
Exact Test ◽  
Group 4 ◽  
Hormone Analog ◽  
The Mean ◽  
Group 5 ◽  
Minimum Daily Temperature ◽  
Mean Time

The reproductive performance of sows is influenced by numerous factors, including environment. The time of ovulation in response to hormonal treatment might vary depending on climate. Because control of ovulation in pigs using hormonal treatments has not been studied in the tropical climate, the effect of hCG or GnRH analog (buserelin) on the time of ovulation in weaned sows was investigated. Thirty-three multiparous Landrace (L; n = 14) and Yorkshire (Y; n = 19) sows housed in the mating and gestation unit on a commercial swine farm in Thailand were used. The average of maximum and minimum daily temperature and daily humidity during experiment was 35°C and 25°C and 31%, respectively. Estrus detection by back pressure test and presence of a mature boar was performed every 6 h. Only sows with weaning to estrus interval (WOI) of ≤7 days were studied. Estrous sows were randomly allocated to 3 groups: a control group (4 Y and 6 L), which was given no treatment; a group (5 Y and 5 L) given 750 IU of hCG i.m. at the beginning of estrus (hCG group); and a group (5 Y and 8 L) given 10 μg of GnRH analog i.m. at the beginning of estrus (GnRH group). The mean time of ovulation was monitored by transrectal ultrasonography every 6 h from the onset of estrus. Interval from onset of estrus to mean time of ovulation (EOI) was analyzed using general linear model procedures of SAS (version 9.0; SAS Institute, Cary, NC, USA). Least squares means and standard deviations of EOI were compared using ANOVA. The proportion of sows ovulating within 45 h after onset of estrus was compared using Fisher’s exact test. Differences with P < 0.05 were considered significant. All of the sows in the control and hCG groups ovulated within 5 days after onset of estrus, but 3 out of 13 (23%) sows in the GnRH group developed cystic follicles; these 3 sows were excluded from the analyses. Overall, WOI was 3.8 ± 0.9 days and did not differ among the groups (P ± 0.05). The breed of sow had no effect on the EOI (P ± 0.05). Although the EOI did not differ among the control (43.0 ± 19.2 h), hCG (40.2 ± 5.5 h), and GnRH (37.5 ± 10.3 h) groups (P ± 0.05), variation was less (P = 0.001) after administration of hCG or GnRH. In addition, the proportions of sows that ovulated within 45 h after onset of estrus in the hCG (9/10 sows) and GnRH (8/10 sows) groups tended to be higher than in the control group (5/10 sows; P = 0.10). In conclusion, results indicate that both hCG and GnRH are efficacious in inducing ovulation at a predictable time in weaned, spontaneously estrous sows. The occurrence of follicular cysts in GnRH-treated sows requires further investigation.

scholarly journals MRI Analysis for Clarification of Mechanism of Ankle Osteoarthritis: When the Talar Tilt Exceeds 15 Degrees, the BME Pattern of the Ankle Are Changes

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0030
Author(s):  
Hiroyuki Mitsui ◽  
Takaaki Hirano ◽  
Yui Akiyama ◽  
Wataru Endo ◽  
Tomoko Karube ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Subtalar Joint ◽  
Pathological Condition ◽  
Incidence Rates ◽  
Outer Side ◽  
Ankle Osteoarthritis ◽  
Poor Prognostic Factor ◽  
Exact Test ◽  
Talar Tilt ◽  
Group 5

Category: Ankle Arthritis Introduction/Purpose: In recent years, total ankle arthroplasty (TAA) has been widely performed for severe ankle osteoarthritis (OA). However, TAA is not always successful in cases of advanced varus; in fact, some researchers have stated caution regarding its indication. Previously, to elucidate the pathological condition of ankle OA using MRI, we investigated that confirmed the existence of an association among the Takakura–Tanaka classification, foot and ankle alignment, and bone marrow edema (BME). In this study, we focused on the talar tilt angle and compared the cases of terminal ankle OA as per Takakura– Tanaka classification (stage 3b and 4) wherein this angle exceeded 15° with those wherein it did not exceed in terms of the mode of BME onset. Methods: Of 616 cases of ankle OA diagnosed in our hospital between May 2009 and January 2018, we examined the MRI images of 52 feet of 50 patients diagnosed with severe ankle OA. The talar tilt angle with the ankle under load was measured using frontal X-ray, following which the presence/absence of BME was determined by dividing the talus, subtalar, and Chopart’s joints into 22 regions (areas 1–11 and 1’–11’). In statistical analysis, we first obtained the total number of BME incidences for each case. Then, after dividing this disease group into severe varus (SV; talar tilt angle = 15° or more) and mild varus (MV; talar tilt angle < 15°) groups, we compared t-test scores for the respective BME incidence rates. Furthermore, we used Fisher’s exact test to examine differences in terms of BME incidence rates between the two groups for each subdivided region. Results: No significant differences were found between the two groups in terms of BME incidence rates for each case. However, the rates in each area were significantly lower in the SV group than in the MV group for area 2 (SV group, 14%; MV group, 57%) and area 4 (SV group, 7%; MV group, 39%), i.e. the SV groups corresponding to the outer surface of the trochlea talar. Conversely, in the subtalar joint, the rates were significantly higher in the SV group than in the MV group for area 10 (SV group, 36%; MV group, 11%) and area 10’ (SV group, 29%; MV group, 5%), i.e. the medial surface of the calcaneus. Conclusion: In cases of severe ankle OA wherein the talar tilt angle exceeds 15°, the load exerted on the outer side of the talus decreases in the talar joint, whereas a greater load is exerted on the medial subtalar joint located at the innermost side in the subtalar joint. Differences in terms of the mode of BME incidence in the subtalar joint, which is not replaced with normal TAA, may be a poor prognostic factor for postoperative TAA.

scholarly journals Congenital Duodenal Obstruction in Neonates: Over 13 Years’ Experience from a Single Centre

2016 ◽  
Vol 5 (4) ◽  
pp. 50 ◽  
Author(s):  
Parveen Kumar ◽  
Chiranjiv Kumar ◽  
Prince Raj Pandey ◽  
Yogesh Kumar Sarin
Keyword(s):  
Birth Weight ◽  
Duodenal Obstruction ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Duodenal Atresia ◽  
P Value ◽  
Associated Anomalies ◽  
Congenital Duodenal Obstruction ◽  
Impact On Survival ◽  
Duodenal Web

Aim: To study the prevalence of associated anomalies with neonatal duodenal obstruction and factors impacting short-term survival.Material and methods: Records of 31 neonates with neonatal duodenal obstruction could be retrieved and analyzed for a 13.5-year-period (October 2003-May 2016). M:F ratio was 1.58:1. The mean birth weight was 2.15 kg; 12 patients were preterm. Etiologies included duodenal atresia (n=23), duodenal web (n=8) and malrotation of gut (n= 6).Results: Associated anomalies were seen in 19/31: Down’s syndrome (n=6), anorectal malformation (ARM) (n=5), annular pancreas (n=5), cardiac anomalies (n=4), esophageal atresia with trachea-esophageal fistula (EA with TEF) (n=3). Mortality in the series was 22.5%; 5 deaths and 2 patients left against medical advice in moribund state (hidden mortality). Mortality in associated anomalies group was 5/19; and 2/12 in the no anomalies group, though this difference was not statistically significant (p=0.676). Similarly, low birth weight (LBW) did not have impact on survival (p=0.639) but preterm status had highly significant p value (Conclusion: Duodenal atresia was the commonest cause of neonatal duodenal obstruction. Associated anomalies were noted in 61% patients, Down’s syndrome being the most frequent. These anomalies did not have any significant impact on the survival, nor did LBW. Preterm status had significant impact on prognosis.

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